Creekview North-CN 911202HOLD HARMLESS AGREEMENT
PUBLIC WORKS
~VI-I~REAS, tJ~ o~e~ of Lot 2 , Block A , of the Creekview
Subdiv~om, 1SA E B~rh~l ~d ' _(ad~), ~P~ T~ (~e o~) ~d~d
~d a~l~ge ~t ~ rgtai~inm w~ll w~ ~ lo~ted on ~
~ o~o ~e ~ of Cop~'s sanitary sewer easement ~d
~, ~ o~ ~d~ ~ a~owled~ ~ ~ ~e ~p~ or
~p~v~ ~ ~e~ to ~ ~de to ~e ~ of Copp~'s sanitarv sewer
w~ wo~d ~ ~ of ~e retainin~ wall ~ ord~ to ~e~ su~
~e~ d~he ~ow~e of~e ~s san~_~ar? se~er
O~ h~y ~ee to ~ove ~& ~ at ~ o~ co~ ~
~u~ by ~e ~ of ~p~ ~d ~ o~ ~ to ~ove ~e ~ upo=
~.m~i~ ~ hold ~ ~ ~s~ ~m ~ ~l~i~ of d~ to ~e re ~a in in $ ~a 11
~ or ~ ~y~ s~ acc~ to ~e ~an~fafy:sewer easemenb Adaifio~y,
retainin~ wall
BUILDING PERMIT APPLICATION
Print or Typ._.~e in a Clear, Legible Manner
Job Address: ~
Lot: ~ Block: ~. Subdivision:~~
Address:
Address: ,,~_~....~ . .,, ;.,"~..~
[] Add ioo
Phase or Section Number:
[] A~eration
Phone #
Phone #
[] Repair [] Demolition
I Desc~ption of Wsrk to be Done
Area of Building in Square Feet
First Floor
Garage
Value of Work
to be Performed ~.?'~,c::~____-~ ..
Second Floor
Other
For Office Use
NOTICE
I hereby certify that I have read and examined this application and know the same
work will be complied with whether specified herein or not. The granting of a permit
does not presume to give authority to violate or cancel the provisions of any other
~-~o~q'~or or Authorized Agent
Electrical Contractor
Plumbing Contractor
v.t