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Thc Uridcrsigned._ — —' �=� � <br />1 � <br />I <br />/. : <br />-�i f �, .�� � <br />Datc Approved � <br />Hereby applies for permission to F'A V f�' f= Y, l S T: __%:_"% �_ --j-, i �;''; ; �:J^.' .'.:'`;`-:. — <br />7i� <br />At the following location <br />SKETCH <br />IWork to be donel <br />` `'_ `_ ( _ _" � �. <br />j( n T' 7'C �c%7 [..� <br />The undersi�ncd ownen c�reby agrces lo hold and save harmless the City of <br />Evcrclt from anv and all daims far damages thal may arise becausc of ihc <br />installation and mainlenance of Ihe improvement herelo applicr' `:-� an,'. <br />(urlhcr agmes to removc samc upon nolice from Ihe City and to n�j�la:_�: a;l <br />public property damaged Ihcroby. <br />i <br />�� �,ir' ,�' � ��i� . <br />6upedor's $ignol(�/e � <br />-,�; ( r;"=C. - =i�� �/' ��' - <br />Dale <br />Remarkt <br />r i:;. <br />,_�� Li����:��.��':1.IaC <br />■ <br />, _. __. __� <br />I — J� <br />I O <br />� <br />i <br />T <br />� <br />� <br />Variancc Required <br />Ycs <br />�;� <br />�,: <br />F�'�`� ��; -� <br />,��� <br />��, <br />t,..,��r. , <br />Signalure of Applicanf <br />Address <br />,- �. . _ � �� - . <br />ielephone Nuniber <br />, � ��, <br />Dafe <br />S /�D F.�-�'__ - <br />Fec <br />D[?T. f�PP�OVALS <br />Enginccrs _ /r�'���'�� � <br />'� : � % i <br />Waler __.,__ <br />Streel — <br />Communicalions � ���•�r�'^.:"'^'� �" �� ' �� <br />Traffic D�i� '-',� S . � : - <br />Plannir� ��"� °r � � 72� <br />�, <br />' - _'' : �II i_;i <br />- G - <br />( t�� �� �lirs� �vh� � �2h HUI'. <br />('cr i F+1 '�.VF� fER I �r.�� C011atflS�ti.'.� . <br />LOC:liln� r, E3E�(�P� !"tC.�\ ^,i .. <br />