Eagle Point-CN 941206HOLD HARMLESS AGREEMENT
THE OWNER OF LOT~, BLOCK ~ , OF THE .
~(3G ~%=, ~_~ ..... .~c fTHE OWNE~~UNDERSTAI~D~AND
~D~SS), Uo~E~, .... ~---- - ON ~IR PROPER~
AC~O~EDGE ~T ~ FENCE ~ICH IS LO~TED
ENCRO~S 0~0 T~ CI~ OF COPPE~ ' S D~I~GE ~;
~ ~, ~ 0~ ~E~T~ ~ A~o~EDGE ~T IN ~E
~PAI~ OR I~RO~S ~ ~QUI~D TO BE ~E TO ~ CI~ OF
COPPE~'S D~GE ~ ~ICH WO~ ~QUI~ ~MOV~ OF
FENCE IN O~ER TO EFFECT SUCH i~RO~NTS; ~D
~, ~ 0~ ~COGNIZE ~ AC~O~EDGE T~T SUCH FENCE
W~ INST~ED DESPITE ~o~DGE OF T~ CI~'S D~I~GE ~E~;
0~ ~BY AGUE TO ~MO~ SUCH FENCE AT ~IR O~ COST ~D
~ON ~Q~ST BY T~ CI~ OF COPPE~,
~ FENCE ~ON ~Q~ST BT T~ CI~, ~ CI~ WI~ ~0~ SUCH
FENCE ~D o~RS ~BT INDE~IFY ~D HOLD ~ CI~ ~ESS FROM
AIJ, C~ OF D~GE TO ~ FENCE ~ICH ~ISE FROM ~ CITY'S
~MO~ OF SUCH FENCE ~I~ ~p~RING, INSPECTING, I~ROVING OR IN
~ WAY SEEKING ACCESS TO ~ D~I~GE ~E~- ~DITIO~Y,
o~RS AGUE TO ~I~SE T~ CI~ FOR ~O~LE COSTS INC~D IN
~MOVING ~ FENCE.
DATE_ / ~/6 ( o~er )
( owner )
Print or Type in a Clear, Legible
Contractor:
Description of Work to be Done
Address: ~)~1~0~,,-[~)~ ~g Phone//:
CI~ of Work: ~ DAd~tion D ~tion ~ Rear
F'lDemoHfion
Io' oock 2enee.,
Area of Building in Square Feet
First Floor
Second Floor
Garage. Value of Work
NOTICE
This permit bccomes null end void if work or construction authorhed is not commence~
within 180 days, or consUmction on work is suspended of abandoned for a period of 180
I hereby certify that 1 have read and examined this application and know thc same to be true
and correct. All proylsions of laws and ordinances governing this type of work will be
GRAY AREA FOR OFFICE USE ONLY
Electrical Contractor plumbing Contractor
Mcchenical ContracWr
=
Lot Are~
ARC TABLE
/
/
lOC ~ 4-46.9
~'ype 'C' Drainage
Fence Length: ,347'