Devonshire 1-CN 921211HOLD HARMLESS AGREEMENT
SUBDIVIS I0~,
(~D~SS), ~OPPE~, ~'~ (~ O~R)'~DE~T~
ACk--EDGE ~T ~ FENCE ~I~ IS LO~D ON ~IR PROPER~
ENCR~S O~0 ~ CI~ OF COPP~ ' S D~GE ~;
~, ~ 0~ ~E~T~ ~ ~O~DGE ~T IN ~E
~p~ OR I~RO~S ~ ~QUI~D TO BE ~E TO ~ CI~ OF
COPPE~'S D~GE ~ ~IC~ WO~ ~QUI~ ~MO~ OF
FENCE IN O~ER TO EFFECT SUCH I~RO~S;
~, ~ O~E~ ~COGNIZE ~ AC~O~DGE ~T SU~ FENCE
W~ INSTATJ.RD DESPI~ ~O~DGE OF ~ CI~'S D~GE ~E~;
O~ ~B~ AGUE TO ~0~
~ON ~Q~ST B~ ~ CI~ OF COPPE~, ~ IF 0~ F~L T0 ~MO~
~ FEN~ ~ON ~Q~ST B~ ~ CI~, ~N CI~ WI~ ~MO~ SUC~
FENCE ~ O~ ~B~ I~E~I~ ~D HO~ ~ CI~ ~ESS FROM
~ ~ OF D~GE TO ~ FENCE ~IC~ ~SE FROM ~ CI~'S
~MO~ OF SUC~ FENCE ~I~ ~P~RING, INSPECTING, I~ROVING OR
~ WA~ SEEKING ACCESS TO ~ D~GE ~. ~DITIO~TJ.~,
O~ AGUE TO ~I~E ~ CI~ FOR ~0~ COSTS INC~D
~VING ~ FENCE.
Building lnspec~ons Division
Lot: ~[L~ Block: ~:~
BUILDING PERMIT APPLICATION
Print or Type in a Clear, Legible Mann~.~
Subdi
Phase or Section Number:
Phone//:
Class of Work: [~New [] Addition [] Alteration
Phone//: ~_l~' -~lOq kC
[] Repair [] Demalltion
Area of Building in Square Feet
First Floor
Second Floor
Gaxage
NOTICE
· Y~is permit becomes null and void if work or ¢onatruetinn authorized ia not commenced
n 180 days, or construction on work is suspended or abandoned for a period of 180
says at any tknc after work is commenced.[
1 hereby certify that 1 have read and examined thts appbcatton mad know the same to b~ true
Signature of Contractor or .t
plvanbing Conuaetor
Value of Work
to be Pedormed
GRAY AREA FOR OFFICE USE ONLY