Waterside P1-CN 930924HOLD HARMLESS AGREEMENT
'(~DDRESS), COPPELL, ~'~:X~ ~n~ ~ j
ACKNOWLEDGE ~T ~ FENCE ~ICH IS LO~TED ON ~IR PROPER~
ENCRO~S 0~0 ~ CI~ OF COPPE~ ' S D~I~GE ~;
~D
~, ~ 0~ ~E~T~D ~ AC~O~EDGE ~T I~ ~E
~PAI~ OR I~RO~S ~ ~QUI~D TO BE ~E TO ~ CI~ OF
COPPE~'S D~GE ~ ~ICH WO~ ~QUI~ ~MOV~ OF ~
FENCE I~ O~ER TO EFFECT SUCH I~RO~NTS; ~D
~, ~ O~E~ ~COGNIZE ~ AC~O~EDGE ~T SUC~ FENCE
W~ INSTAl.LED DESPITE ~O~DGE OF T~ CI~'S D~I~GE ~E~;
O~ ~B~ AGUE TO ~MO~ SUCH FENCE AT ~IR O~ COST ~
~ON ~Q~ST B~ ~ CI~ OF COPPE~, ~ IF 0~ F~L TO ~MO~
~ FENCE ~ON ~Q~ST B~ T~ CI~, ~N CI~ WI~ ~MO~ SUCH
FENCE ~D O~ ~BY I~E~I~ ~ HOLD ~ CI~ ~ESS FROM
Ar.v. 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~TJ'~'
O~ AGUE TO ~I~SE ~ CI~ FOR ~O~LE COSTS INC~D IN
~MO~NG T~ FENCE. ~ ~
DATE /~ ~ ~~ /~er~ ~w
Print or Type in a.~lear, Legibl.__~.._~e Mann_~
Description of Work to be Done Class of Work:
Address:
Address:
Phone #:
/$ o
[] Addition [] Alteration
'--,%/
[] Repair [] Demolition
Area of Building in Square Feet
First Floor Garage
Second Floor Other
NOTICE J Permit Fee:,~0
Tins permit becomes null and void if work or consh'uction authorized ~s not commenced J ....
within 180 days, or construction on work is suspended or' abandoned for a period of 180 [ ZOrllng L/lStl'lC~l
days at troy time after work is commenced.
Approved By:
I hereby certify thai I have read and examined this application and know the same to be hue
and correct. All provisions of laws and ordinances governing this type of 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 federal, state or local law
regulating construction or the performance of conshuctinn.
· Signature o~ntractor or Autho'~l lgenl Prinl
Value
of
Work
to be Performed
GRAY AREA FOR OFFICE USE ONLY
Receipt Number: (~Q(~O~7o~
Occupancy Classification:
/ Date: (
-StTE-PL-'¢