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<br />05/22/03 THU 10:03 FAX 612 784 0082 <br /> <br />CIRCLE PINES-LEX PD <br /> <br />..,....... CV CITY HALL <br /> <br />III 008 <br /> <br />INSURANCE: Your ins1lranee e<werage must be reviewed and approved by the <br />City's insuruce carrier. <br /> <br />1. _ Public liability insurance naming City of Centervi1le and other public agencies <br />additioDBl insured is required. <br />2. Hold harmless forms executed and failed. <br />3. _ List aDd approve/disapprove other insurance coverage as may be required. <br /> <br />6. <br /> <br />BUlLDINGDEPARo/; ~. . <br /> <br />Approved by; r <br />Signature <br /> <br />Title <br /> <br />Date; <br /> <br />Electrical: <br /> <br />1. _ Plan l:hecklinspectl.on of any wiring installed on a temporary or permit basis. <br />2. ~ Permit(s) attached. <br /> <br />Structural Plu: <br /> <br />1. _ Plan checkfUl.Spcction of any temporary or permanent structure&:, including <br />bleachers, scaffolding, grandstand, reviewing stands, stages. or platforms. <br />2. _ Pennit(s) attached. <br />3. _ Other provisions as may be required by this department: <br />