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G/ <br />3��-� <br />h <br />Date <br />v_�� � /%�I <br />� <br />APPLICATIUN FUk = �l�"��' � � �� ����/ �L� S'/'G- /Y� <br />5 3 / �/ ..,.2 -��rf' �. . <br />The undersigned owner hereby aqrees to hold and save harmless the City <br />of Evere{t from any and all claims for damap�es th�t may arisa because of <br />inst311a{ion of the improvement hereto appl�ed �or� and further agrees to <br />remove same upon notice from the City and to replace all public property <br />J,m3�ed {hereby, <br />,a , ( ' ` � / <br />Si�r,e�i ���' �� ��t4�.�-.i ------/-- — Uwner <br />/V/_�7/v'/��.IJ� �'/�� C��C' /1/�.-- -C.cntractor <br />� � �i(...�i )� �t�t�'_ <br />