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L <br /> SIGti PER!•fIT APPLICATIOt1 � • <br /> ' SUBI4IT EVIDfi1�CE TS1T�T EQUIPII£.NT ' �J� �ql J <br /> C0:1PLI�S P7ZT11 i1:E STe1i:D7�RDS OF • • �///•/� ' <br /> AN APPROVL•'D TESTIIvG LABOI27�TORY. � <br /> � INSPECTIOt�' OF SZGN REQUZP.ED . <br /> $EFOIZE EP,ECTIOI�. <br /> , . GiLL 259-6745 FOR ItdSPECTZON. " <br /> � ' Application Date � - ( ( - � Z_ <br /> ADDPWSS � a O1 ��v�-�� ��-, _ <br /> The undersigned owner hereby agrees to hold and save harmless the <br /> City of L•'verett iro:n any and all clains for damayes that may arise <br /> because ot installat-ion of the improvement heret-o applied for, and <br /> furL•her agrees to remove s:.me upon notice from the City and to re- <br /> ' place all public property dar�aged thereby. <br /> . • . . � .� • VALUE: (� � <br /> � � . <br /> . � ' � . , . . . . - ,. CIRCUITS: � . �• ` <br /> , ...�,'•. <br /> . ' • c:. ._• .. ' �FEE: � � <br /> . ; •• :.,. . r ELEC:'RICAL: <br /> . . TOTAL•1'EES: I <br /> I ; i(� . . , .. . '- .:, <br /> - . � .�S_ 7� ,.� . , . <br /> . � <br /> � . �'.� S' �� �: � : <br /> . . ;����7:Z. �' . ., . . . . :. . . . ' :; <br /> � ' . � � . . •, .. . . . . ,: . . . . . ' .: <br /> .� :' ,,.. . .. . . . � . . �. , . . . . ..� <br /> , . . . . . . _ , ;�r <br /> � . • • . <br /> , . . . •' , •' � <br /> . . . � <br /> '�' ' .. � . • ; ' , • ' � <br /> � , . ; <br /> � . , <br /> \ . i <br /> Signed -:�� � /. .. . . Owner <br /> � , '�_'.__._.-- ( - � � <br /> \ ` Contractor ' _�' �:e f . . � <br /> • ' I <br /> License No. - r r <br /> � ' • . . . . , <br /> . � <br />