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_ �1 <br /> i <br /> � <br /> P ) <br /> � r.l� <br /> M SICN PERDIIT �;tPLICATION <br /> � <br /> SUIIMIT El'IDCNf,E TiL1T I:QUIP�tENT <br /> COMPLIES WITH T11E STAt7DARDS OF <br /> Atl APYROVED TESTIt�G LABORATORY <br /> 7NSFECTION OF SIGN REQULRED <br /> flF.FORE ERECTION. <br /> CAJ.L 259-8745 FOR INSPECfION. <br /> � <br /> �i L' /t� /c c��-� �� /�a�L�%�J APPLICATION AATE :�� �/- � <br /> -- I <br /> ADDRF.SS I�fJ� %� G�II//�>,:� :, .' <br /> The under�igned cancr hereb}• a�recs to hold and save harmless [he i <br /> City of G�•crc�t from nny and ell clains for damnges [hat may arisc <br /> oecnusc of instnllatlon of the improvcment hcreto applicd !or, snd <br /> . fur[her agrees to remove sane upon notice from the City [o nnd to re- <br /> plece all public p:•eperty dnmaged thereby. <br /> ,. «� 1 <br /> � • vnLue: -��y_ _ <br /> CIRCOITS: ����-���1 � <br /> ., <br /> � � FEE: :i. L � <br /> � �) <br /> �� �-��Or.l .rfllL�c_�A;l; ELECTRICAL: ' > , � � <br /> \ � _-- <br /> TOTAL FEF.S: - <br /> — - ,i <br /> � ra�Y ' ' �' ---� <br /> I 1 ._—T_� . <br /> � I � <br /> ..J. � . � � � I <br /> � ' � i <br /> �� �$� �T 5 Crtn N� � � 1 � ' ,� ', <br /> J ���� �n?3�F - -- <br /> � S'L�ur'cr T� � <br /> v R.�o C Q�l �/r u I <br /> � _� jcitc-�,i;; <br /> - - - , . <br /> ' <br /> i <br /> � ' � - <br /> , � _�A� <br /> � � . , <br /> L 1�Z:;.., 7���:,c-sr 1� <br /> \� .f,1-� (L/�C{�. �'V` l �� <br /> \ � � 1/.�1�VL�S . ��I��) . . . <br /> � -�Al�—.S�IL-I�ii.�Sa / <br /> SIGNCD r � �4 1�.. _ OWNF.R �/ _ µ ^ <br /> :� � � � � y � <br /> CONfitACfOR i � � � Z�1, . <br /> �� � � � � / �/,l(�I! - <br /> , y ticeNsc No. . : �`/lC � ��' �_ 5 -l- 7p�d' <br /> r' / <br /> ` �1 'J�,{�l 3�/�� <br /> -�r <br /> � <br /> � <br /> � <br /> . <br />