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Thc Undcrzigned <br />Hereby applies for permission to � <br />C'�� �i ;�, '�' ,_,T <br />At the following locafion �- <br />SKETCH <br />IWork to be donel <br />� 1'itCiV!l �r - � % , <br />���;:���E_It nf:.nii��lwE <br />---•---------- � <br />'NOTS <br />,•ri��K ��nrH wnrErt <br />I�CPT. Ft`r `.'.'1TER I.INE <br />� l-�'�f,.� ' �.. . � - f'/r►�/�T�n�� <br />s <br />�', ��• . ,- - ' �%/� <br />Da�c App�oved <br />�r <br />The undersigncd owner hereby a9�ces lo hold nnd save harmless �he City of <br />Evciell Irom any and all doims lo� damages thal may arise becnuse ol Ihc <br />installalion and mainlenance of Ihc imp�ovemenf he�elo opplied for and <br />lurlher agrres b remove same upon nolice Irom Ihe Ci�y and lo reploce all <br />public properly damnged Ihereny. <br />> <br />`, �. / <br />1/% / [ i I=,1 � l��rl <��� _ <br />Inspedo�gnofure <br />,� <br />/ , <br />. <br />�: L.---•-- - - - - - - <br />Dale <br />r <br />7 5 rN S TREET <br />/1 CL✓�-4 / t % J11��C:'� `J[( <br />Variance Required <br />Yes <br />No <br />.i� � / � • A ' ��.,/ <br />-' Signaf re o( Applicanl <br />L; I77 - j- Addre:s D/� p <br />��.= � L - �� - ' j '� Q <br />,. : <br />":'.� Telaphone Numbe� <br />���r �,�,_o <br />Dalc <br />s /`; �'- � �i., � <br />F�� <br />DfPi. APPROVALS <br />[nginccrs — <br />Waler <br />Slreel � ` '`" ` � �'�` <br />Communicolions - <br />Tra(lic — ---- <br />Plnnning _ _ <br />