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The <br />i <br />Hereby applies for permission to ��� �'�' -% !J ` `'�' — <br />At fhe following location C�� �- S%��- v/'��D.E.� — <br />SKETCH <br />IWork to be donel <br />The undersigned owner hereby agree: to hold and save. harmless the Gity of <br />Everelt irom any and all cluims for damages tfia� may arise because of the <br />insfallotioii and maintenance of the improvement hereto opplied for and <br />further agrees to remove same upon notice from the City and to replace oll <br />public property damaged thereby. <br />�lJ7w�p.�,t�, 2,/� 9�7v, <br />�"`i �' _. <br />�' „ <br />,'� / <br />�'�-:,},'"�Y ( �:.+tic_s�4..ti.. <br />�� <br />InspecPor;f $ignafure y <br />���? � � -- <br />Dafe � <br />�4y <br />�rl����¢r 2.3,19c� <br />Date Approved <br />Varionce Required <br />Yes... _ _. _ _ .............. <br />No._ ............. _.._. <br />Signalure o1 Applicanl <br />add�e:: <br />Telephone N�mber <br />Dale <br />5 <br />Fee <br />DEPT. APPROVALS <br />Enginccrs ����^r-�- <br />Woter �_ <br />Slrccl <br />Cammunications <br />i / ' � <br />Tmf(ic <br />Planning <br />i ;t' <br />