Lakewood Estates-CN 931101HOLD HARMLESS AGREEM~,NT
WHEP. F-~, ~THE OWNER OF LOT
-(~D~SS), COP~, ~ (~ OWN~K; ~DE~T~D
AC~O~EDGE ~T ~ FENC~ ~I~ IS LO~TED ON ~IR PROPER~
ENCROAC~S O~O T~ CI~ OF COPPE~ ' S D~GE
~D
~P~RS OR I~RO~S ~ ~QUI~D TO BE ~E ~ ~ CI~ OF
COPPE~'S D~N~E ~ ~ICH WO~ ~QUI~ ~ OF T~
FENC~ IN O~ER TO EFFECT SU~ I~RO~S;
~, ~ O~E~ ~COGNIZE ~D
W~ INST~ED DESPITE ~O~DGE OF
~ON ~Q~ST BY ~ CI~ OF COPPE~,
T~ FENCE ~ON ~Q~ST B~ T~ CI~,
~OV~ OF SUC~ FENCE ~ILE ~P~NG~
~ WA~ SEEKING ACCESS T0 T~ D~I~
~MOVING T~ FENCE.
Print or Type in a Clear, Legible Manner
~pfion oe Work to ~ ~ne Cla~ of Work: ~Addifion ~ Alteration
Phase or Section Number:
Phone #:
[] Relmir [] Demolition
·
&rea of Building in Square Feet
First Floor Garage.
Second Floor Other
NOTICE Permit Fee:
This permit become* null ~nd void if work or construction authorized is not commenced
within 180 days, or construction on work is suspended or' abandoned for a periocl of 180 Zoning District:
days at any time after work is commenced.
By:
hereby certify that I have read and examined this application and know the same to be true
sad correct. All provisions of laws and ordinance* governing this type of work will be
complied with whether *pecified hcreln or not. The graining of a permit does not preaume to
give authority to violata or~janc¢l the provisions of any other federal, state or local law
~Authorized Agent Print Name
~:m'M Contractor Plumbing Contractor Mechamcal Contractor
GRAY AREA FOR OFFICE USE ONLY
Receipt Number:
Occupancy Classification:
Date: