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r <br /> _.'iZCt� P�.x1IT APYLICATIOt7 ,'{ <br /> � � . <br /> SUSPfTT EVIDEtiCE THAT EQUIF:C;.i : <br /> , C0:'PLIES NITH TitE STAP1D,lRDS OF <br /> i A17 APPROVED TESTING L1BOF:.ITORY � <br /> � It�SPECfI0;1 OF SIGN REQIIIRED <br /> J BEPORE GFECfI0.1'. ' <br /> i:��'� C1�T.L 259-8745 FOR Ii7SFECfIOti. � <br /> { � APPLICATION DATE ,��6� 7� � <br /> ' / <br /> � � ADDRESS �Q�' ��'��/ r�-- # <br /> 4". ' , —�----i - <br /> �� � Thc undcrsi�ned oaner-hereby agrecs to hold and savc harmless [he <br /> �: ' Ci[y of Evcrett from any and a21 claims for dacages Chat r�ay arise" <br /> �j ` , because of insCallation of the improveoent hcreto applied for, and <br /> �' • fur[her agrees to remove sane upon notice fro� thc CYty to and [o re- <br /> :' Place all public preper[y damaged thereby, <br /> � VAI.UE: ��� � ) <br /> j � CI?ICUITS: � <br /> � � <br /> s <br /> ' FEE: <br /> � � . �-R+.�Fot�-�vi/�_ <br /> � ELECTRIGIL: ��.tY�lh Ciy►-iC,v��'�'�-' '.-�= '-"-�- <br /> i` <br /> �. f TOTAL pEES: <br /> 6 � � . <br /> � � � 1 � 11 <br /> Q � � <br /> ,. . <br /> t � . �u,F..�ps <br /> f ' Y'Lp�a.c.�,-a..�s-��� a �` ��.,, <br /> ' � (�Ml�k � � � <br /> f ""�'y � - y-t►.u�v�. d/� �?►z+,�c�-r'w� s i��� . <br /> t �. . � � <br /> ' � . ' <br /> il . �` �� , <br /> a . . �, � �' �4 rh' • � <br />! ° � <br /> � , . . <br /> � , � <br /> ' • SIGtiED � � ��y <br /> \7P�Lt,-GdUI�MP:� ��1e.. cS�a�c. aat�rsR�� �"^�"� —� <br /> I � COtJTRACL01: �, �1L��J �� �f�/L � . � <br />� • Licer,se t;o. SI f�4G ()� Gz��P3 . - . <br /> � ; , <br /> i � <br /> ; <br /> � � ;- -:� , � _... <br />