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SIGt� P�RMIT APPLICATION <br />SUP,t4IT ]iVIDliNCE TIlAT .PQUIPMPNT <br />co:�rr,res wT.�rn T»e STA17DnRDS or <br />At7 AI'P7tOV�D TESTII�G LAllORATORY. <br />itrsrrc�r�:�i� or szcta REQUIRIs'D <br />e�ro�iL r.RLcrroca. <br />ChLI, 259-87q5 POR INSI'ECTION. <br />Application'Date <br />IiDDRSSS ,; � <br />/6�" � �� <br />�' �1i� <br />The undersigned owncr hereby e,grees to hold and save harmless the <br />City of Everett f.rom any and all clair�s for damaqes that may arise <br />because of installation of i:he improvement hereto applied for, and <br />further. agrers to rcmovc same upon notice from the City and to re- <br />place al.l. puLlic property dariciged L-hereby. , <br />vnT,v�,: /<<"O <br />."- _ <br />CIRCUITS: �:Cv�- <br />I'E�: �� � i9 � <br />1.LI;CTI�ICAL: � � � � <br />TOT�, r�ss : <br />, <br />i� j� c�c�� �- iC � STi��.S <br />� / � � � <br />� � lC ',' ",v <br />Signed <br />c ���Y <br />0 <br />O . � C' <br />�"�- /7/7 <br />Contr�ctor <br />License No. <br />� <br />Owner <br />