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- . . . . . .__ _. .. . . .... . . . . . . . . _ �'�I :.,l � . . . � <br /> " A?FI_IC�1TI�iJ FUfi Rli;lli•UP�:';AY USG PF.RP�iIT ' <br /> evrrcU _ � � r <br /> �,.,.`$� ' ���Gfl/1//[�' , ., <br /> . ����.,� • ' <br /> � CITY f?NGINECRS 74 '� <br /> � EV[It6Tl', lVi1SIiINGTON PFR�b11TN0.__�- t <br /> Illic Ui:dr.rsi9ned r'.� �� !r:;� � — -----------. ---- <br /> Iflereby applies (or pernnssion to _ - Ii.. � : _r_..y'--Y i�,v!•ri r � U�vi ' '' _ . <br /> � ----- -- - — �' <br /> At Uie (ollo�ein� loe:,'ion_'Z /i 4� ?4 r�+ �> T/7 'S r�o;.r „c t>r � <br /> SKETCFI - ! - <br /> �N.'ork to bc donc) � - ' <br /> . . fA <br />. �'?(: i::�. . . . . .. � <br /> . ' � <br />�I <br />� <br /> � ' <br /> �\?GTc ; Cpf�iPL�� Ul17H Gt�l''y . �oDE � 'cG�t� li.�EMt �� � �'� <br /> �L.G`f"lDl.] 13. � � " rJ� l��rll�r'1yS�, . <br /> A C..o�y o F '�'1+t Co p C- �5 ,� -r T'!1 r �I t'� .D <br /> TO -rt-t� s � C�rrzM �T, ��r� y' (�,°� E"� TIC()f_ � C , � <br /> � t'� -t T �.. � -n ���..� To �t �, �✓ LLOc�.J 1 � Cj 5�F C-t'TO t=�5 � <br /> aF c.a�v . 13, 16 , v � o � 13 . � � �Oyo � � <br /> 5J f�78 <br /> ;� , . <br /> De�vEtYnY SECTION The undersipned o vner hareby agrees to hold and <br /> NO SCALE . . save harmless the Ciry cf Fveret[ tinm any ,nd all <br /> r 'I elaims for damages Chai may arisa ber.;;use oF instaila- <br /> �— #1" LIP � iion and maintenancc of the improvement here[o <br /> I 30' I �— 30' apptied for and (ur[her agrces to remove samc upon <br /> I"�� , ---�--� notice from the Ciry and to repiace public property <br /> dany�,ed Ihcreby. . . <br /> ��+.��•.�'�-' <br /> � Signaturz of Applican[ —� <br /> i/ � i�- ..�.-��e-��-- <br /> COP'f OF TFIIS/�PPLICATIUN TO � Address <br /> BE POSTLD OPJ J0f3517E � .�,.-�t „�." ���,� � <br /> Te�ephone Nurnber <br /> CALL BVGIfdE[RI�G DEP-�. 259�2Y,11 ��__�Z� r+ j � <br /> 2•t I-IOURS OEFOHE CONSTRUCTIOiJ � Date • <br /> -------------- / z�2 c�'�-- <br /> CHFCK LIST Ce' %J '-, � �/y�lp L.1 /%7t�— <br /> 4+�,�ar v,�ve � • Dcpt. Approvals %Ea E�' <br /> Drei�ia e � . , . . <br /> 9 i ,� / r <br /> Curb Ya G�ittcr I- . �ipinccrs_1 �/.l G�'`i: >`� .-- _ <br /> Sidewalk � � . <br /> J 4Vatr.r <br /> � Strect <br /> I �/ ^�� � . Communication: <br /> - Inspecwr'sSignature � 'I'raffic <br /> � �J" Planning____,__ <br /> �--��---�" _ . <br /> Uale — <br /> � -- - -- <br /> � Remmks — --- — -- � <br /> IAlotc: Oriqin,�ItoCustomcr . - ----- <br /> � 1 Ca:p( to Fild t` Q '--.'.. ,-.— .— <br /> �l_1. �� :} � , <br /> 1 Co;i; W Ir�+par.tor Appc\evr�i !rI. I�/ <br /> i � _.__'�`'' --(_-/--`-; '-'(? 'i -��� <br /> ! <br /> _,� <br />