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; t r�' ,� r� iy7-�,r <br />The Undersigned � � � �� ��1 � z'' ��� F �a Datc Appwvcd <br />Hereby applies for permission to -tif L`l: _ .�-+� J'1' p) 1— 1 P.7'� �-1 1C' � 'J 1, t -- _ �r=1 `�.' "� <br />ti _ <br />u-� �� <br />At the following location L � � �-- SLI � `^ • � • � � � '� - <br />SKETCH -- --- --- --- -- _— - — <br />IWork to be donel <br />SU�nM�T <br />Thc undenigned owner hereby agrees to hald and save harmlesz ihc City of <br />Everelt Irom any ond all cloims for damages that may arise because o( ihe <br />installolion ond mainlenance of the improvemenf hcreto opplied lor ond <br />(crther agrees lo remove same upon nolice fmm the City ond la reploce oll <br />public property damaged ihereby. <br />�+ ,C i �� � <br />L .�Yili�ls'/.(„y i ' ')t? - �-•� !�.":,i //';,''i�' <br />Impec�l r's Signalurn <br />/ <br />�7iir C_l/r�.<._�i7 �3�;'!:'_�t. <br />Dale <br />IirGl. 1�ii �C�1"i <br />� u <br />� r:lere <br />� , slarted. <br />c ��� ' <br />O <br />d. <br />� <br />� <br />� <br />Variance Rcquired <br />Ycs.. . .... <br />No _ <br />�_ .� <br />��_ <br />1 � '�. <br />,%�Gl�'lG<s��� �` ��.�-�/��,1 <br />� �,�` � ; Signalure ol Applictinf � . <br />� C 7�- <br />.. i x��Ji ��, C��� )�J �L.C.�- <br />Address <br />. � ,� �� � — �� ���� � <br />ielephone Number <br />/ <br />��- v'1 i i r �� <br />;��7A c .% :>�L-�/ / . / `,�" <br />Dale � <br />5 �l�o �rc� <br />����, �J �% .�-G. Fee <br />� ��� y�� <br />DEPi. APPROVALS <br />�, . � <br />-- �',ri � .�,� <br />En3incers -- <br />Watcr - �-�` !� �'-'� _ <br />Slrccl ' ��' � — <br />Communiwlions " - � <br />Trallic <br />Planning � ' � <br />!VO'1'G ���.. , � ���.; <br />CI II (,K VJI IH VJATCR I piiOPER GhAli:, <br />�,�I r(1R';' 7�kUItiF <br />�_ .T ! ��c b ���P. =Y.(.'AVAi IOte <br />__. . . .. _.- � ..<<,..�. <br />