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EVERETT, `:.''.05H. <br />;' <br />The Undersigned. � '� ��-- <br />Hereby opplies for permission fo =-�'�''• �— <br />. <br />At the folloHing <br />SK[TCH <br />IWork to be donel <br />� �E <br />s �� rcti <br />Thc undersigned owner hereby agrees lo hold and savc hormless �he City of <br />Everelt from any nnd all daims ior damoges thot may arise bemuse of Ihe <br />insfallalion and rt�aintenance of the impiovemenl hereto applicd for and <br />fur�hcr agrecs to remeve somc upon nolice Irom the Ci�y and tn rcplacc nll <br />public property domaged thcreby. <br />-�� � - <br />�'�� � ,_l.� , /G� `� <br />� i ,�l�l <br />1 �" ' � <br />Inspedoi s $ignafure <br />Dule <br />--- -APPro�ed -By --� --- <br />�.L �� ' ` <br />1�,� i <br />le Approved <br />Variance Required <br />Ycs <br />Nn <br />��,�c,�. ��� <br />$igno�ure ol Applimnf <br />2qi� �o.�•o Sr. <br />add�e,: <br />—'Q�"' �,�/1 <br />Tclephone Number <br />/i�y 9� /5'� � <br />— �a�� <br />5 <br />r�� <br />DEPT. APPROVALS <br />[naincCrs _ <br />Wolcr _ � '..�� � •. <br />Slrcet �M `• i / ,6 , � .i ��- c ,_ <br />r <br />Communications � ��I��I <br />7ra��iC � i� �-�r) /%'. <br />f'Inmm�t� __— � <br />