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� <br />SICN PLRr1IT APPLICATION <br />SUBMIT EVID2NCE TFtAT EQUIPMENf <br />CO;fPLICS NITiI TItE STAP:�ARDS OF <br />AN APPROVED TES'PIRG LAIIORATORY <br />It7SP�CfION OF SIGN REQUIRED <br />BEFOP.ti ERECTION. <br />C�1LL 259-8745 FOR INSPECYION. <br />APPLICATI0:1 DATE <br />ADD::ESS <br />3 <br />• .� <br />The undersi�ned owncr�hcreby aErces �o hold and save harmless [l�e <br />Ci[y ot E�•crc[t from a m• and all elair..s for danages that nap arisc <br />because of in:t111ation of the imprc.ecent here[o applied for, and <br />fur[hec agrces to remove sane upon no[ice from thc City to nnd [o rc- <br />place all public p:uper[y dar.aged [hereby. � <br />VALIJG: /00 � <br />CIRCUITS: � ' �"X�S�i'A.G <br />FEE: <br />SIG'�'ED iA� <br />COi�T,^.ACfOR s�s si G... GG. <br />I.Ir,E1:SE N0. , f i�7S % <br />�j�o i� �vzc^� <br />£LECTRIG:L: <br />TOTAL FEES: <br />0'at7ER <br />.. :: _ . .._ , :.,. - .�,..�:. - <br />'� � -��z�� <br />� z � 7�; �f �e � <br />��z���9 �L <br />