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i <br />� <br /> SIGI� YEI'�•fIT AT'i�LICA`PI01, � <br /> ' S�Jr 1�fIT EVIDENCE TIIAT S�QUIPPSENT ' <br /> CU.'9PT,I�; P7ITli i11B STAIIDARDS OF • • • <br /> ' A:t I+YPROVLD TliSTING L11BOR11TORY. <br /> I17SPECTION O,^• SIGN REQUII2ED . <br /> $ErORP ];RP•.CTIOII. <br /> ChLL ?.59•-II74S LOR II�SPECTION. ' • • <br /> ' nPPli.cation bate ,/�,,.,`/ Z �,. ��/ 7� <br /> , '7----� <br /> ADDItESS Z � 5 � . . ' (�r�'rte'! iJr1�� �, . . <br /> j <br /> The tmdcrsigned owner her.eby agrees to hold and save harmlecs t.he <br /> CiEy of L•'veret:t irom any and all claii�s Lor damages ihat may ari�c <br /> bccause oi ,S.nstallai:ion of the improvement hereto applicd for, and <br /> f:urL-hcr. agrec> to r.emove same upon �otice from thG City and to re- <br /> place all� public pr.operty dar�aged thereby <br /> . . . . . . • VALUP: �3 C'�' n . . . , <br /> . . , . - � --- <br /> ' � . . . : CIRCUITS: . <br /> I • . . L . �_ _ . <br /> � . . .. . . . . , � . ,� �'1 . � . .- <br /> I • , .. PBL: ��Z. �� � <br /> , <br /> , . • ''. ` � lL�C'�I:ICI�L: _ , <br />� ; � . . . . . .� <br /> I ,, . �oTnr,�rL�s: (Z -�v `_ � <br /> 1ZY6 �l,:e, : <br /> 1 � . <br /> . • .. . . .. <br /> 4 . � - _ ,ll; : : ' . - . . .. ' , � . <br /> _ Gc.�y� <br /> . � <br /> z <br /> � 77 <br /> � . <br /> I, � . � . : . .. � : : <br /> �: . . �-, , �: : �.. c- . �/;�� �-� .. . � - � . ,; <br /> � ; . , _ . <br /> _.. . � I/ . .. � . . L. . . . . <br /> ,� ����- . �` �7�1�� . . . . , . . :t <br /> r �. � � .- : � .. . : ; .� <br /> � . , . <br /> � . , . <br /> � Signed �7oL.-� .� .. .� . . • . Owner <br /> v • <br /> � � � (� �� -S��'y� <br /> ��� Contracior. 'Y �' E'✓ �' ` ��ic,�;,i.�,_ �cz�O.. S I <br /> �C Liccnse No. �-- . I <br /> \ ' `�' , <br /> �; . <br /> � <br /> i <br /> � <br />