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� r/ TJff� <br /> SUT3MIT 17VI1)ENCr TIIAT �QUri�MGN'I' � cJ <br /> COMPLII's5 WITII TIII; STANllARllS Ol' <br /> TII� UNDERWRITI:I2S' LAAORATORY, /�����__ <br /> � <br /> INSPI?CTTON OL' SIGN R�QUIRED <br /> 13�FURE ERECTION. <br /> GALL 259-8745 FOR INSPECTION. <br /> i - <br /> Date _��C" �� Z �7� <br /> APPLICATICN FOR � /t ���r� "' ' ���„�.� /��_������ <br /> J��.33 ,�r���� �_ <br /> The undersigned owner hereb agrees to hold and savc harmless the City <br /> of L•'verett from any and all claims for damages that may arise becauae of <br /> installation of the improvement hereto applied for, and further agrees to <br /> remove sarne upon notice from the City and to replace all public property <br /> damaged thereby, <br /> �S� ��Y w r'Y ; � �-� O U <br /> �/,r�� � VALUE: 3� . <br /> / �� __�,CUITS: _ _ d�i( ,_ <br /> _— Z XL1C �i L/ia�-t <br /> �i��sa.., �1l.e�(( � � �.' ' - • � <br /> �� Ctluw� �r. �(Lu ,', ,� � % � ,_� �� �� � < .; <br /> 1 J�rsx Z"r3„X� ,� <br /> I � <br /> , <br /> ►C�. <br /> �._ ,� i o�1 Clipy�l.a ��o�. ��^ ;,, � oi5 �_. <br /> ,� i„ <br /> t `� X �%- ��s <br /> l� BI��• <br /> I � Y 1 V <br /> , <br /> �/ Y�� /'7�f'%C' S <br /> C veQ �s��ru �(��� �l 33 � r 0 c��'u'�'� <br /> . <br /> �r -_--� - � '�"- �' , <br /> % � �' u <br /> Signed �---�i��''�7?-Q/� � . �� /�/� l <br /> Owner <br /> Contractor <br /> /�� �-;� ����� (�c �':'C:i,�iT <br /> prr c� �ver<crr, /{FPIiO'���'J �v� t3iJ{LfJI( G P .M1� <br /> C.OMMUIV1t,>!Ifii.iF V���r <br /> Z�1�i vLM��r, ir..h• � 7 <br /> Evn�pn wa:-a����<�..�,. L/�v /D/�/� d�tC 'U/�!�7 ...__�Y � . <br /> %.�,✓. (9G� (�G.� (9-1s- 7� <br />