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EVEhLIi W'ASFI. <br />Thc Undersigned L' - �- ' - � I � <br />Hcreby applies for permir.ion to�..�t-�,� � T v� F�� � <br />�� thc following lomtion � > � r — _ . f�=' ` % <br />, � � ---_... <br />SKETCH <br />IWork fo bc doncl <br />�: _ ,^i <br />-- - - --- 75_ r�� -- �S�E�.%_ <br />Thc undersigned owner hereby agrecs lo hold and save harmless Ihc City of <br />[verelf Irom any and all cloims lor damages ihol may arise because o( Ihe <br />inslallalion and mainlenancc o! Ihe improvemenl herelo applicd (or and <br />lurlhcr agrces lo removc same upon nolia (rom ihe Cily and lo replocc all <br />nublir, properly damaged �hcreby. <br />J'', <br />�� . <br />Datc Approved <br />, <br />— �,� � ,� —�. <br />�CJ %� .! <br />NaT T� nE "�r <br />ani � i rl' i-'�r. ,•���'7Y. <br />�rwi� . <br />gCALE I"= . ' <br />I � <br />�,�6,(� J-L _- An <br />_ ' A.0 c�� �+ / r . <br />��� + i o , r .., <br />�, '��:}•qF.'. („/_. . � J�i.-:/.. /�i <br />/,�b J %'�lLL E�.(/ vNQ/,'!' /f/(/Y �.� �.�,y .. <br />/ � /,' FvTvi�" /J/'Ai.vti G f. <br />.. � �' ).r' <br />� ,. - , . ., r,,. <br />Inspeclois Signalure ' <br />--- _ _ —_ _ <br />Dafe <br />Remorki <br />Voriontt Required <br />Yes <br />IJo <br />, 2 ;�� <br />��'� ,�..-�.�_..�'i/ . <br />Signafure o/ Applicanl <br />R /G � Lt/, C�'t [f'N ,�, <br />Addres: <br />3'� _' - _', J. �' <br />ielephone Number <br />S <br />Dala <br />r�� <br />o�rr. nrraovais <br />6 -� . <br />6i�inecr _ <br />�w�i�.�_ s. <br />s�ree� r� <br />Communicalions � �al. <br />Trallic <br />Planning <br />�- U�,��-�� F,cll i,�..s�,9� �� ��r�,�. <br />