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_ SIGN PL•RMIT APPLIC�TION <br /> SU[iMIT EVIDGNCE T.}iAT EQUIPP�NT <br /> , COP4'LZES .UITH TllE STANDARDS OF • <br /> AN APPROVED TESTING LABOR.IT_ORY <br /> INSPECTION OF SIGN P.EQUIRED ' • <br /> BEPORE ERECTION. • � <br /> CALL 259-SJ45 FOR INSPECTZON. � <br /> ��2��� l�����j I/ r uS IC�APPLICATION DATE �� ` � � ` l� <br /> ADDF.ESS 'T P�O� ��tJr7ZC��c A� �JL%� , �-C ) ��c� � ��iC ). <br /> . � <br /> , .' The undersigned owner• hereby agrees to hold and save harmiess the <br /> City of EveretC from any and all claims for damages that may arise <br /> because of installation of t}ie improvement l�creto applied for, an� <br /> . . further agrees to remove s2me upon notice from the City to nnd to re- <br /> place all puUli.c property damaged [hereby. <br /> � NS'iY��.Lp.Tl�c�tU O� ��1Cl�TIcJC <br /> � VALUE: ,_�L-�tJ� o fJ �'�t,'t�.—� , <br /> CIRCUITS: � � <br /> � FEE: <br /> • ' ELECTRICA?.: <br /> - TOTAL FEES: ' <br /> � �� r 7� z�' ��� � . <br /> �vr2� � I-lo-� � � <br /> ��� <br /> • SIGNED � OWNER � <br /> co�r�nncror. (�.J��I��Jx �I�r�l " 72%'dk�TIOG`� . � f�/(U�j ``l� I �O-lr-1 <br /> �, • � <br /> • LICGNSE NU. � � !' r� ��� � _ �J�LL�.l1(,��'� C��), <br /> ' �l�,O�C� ' <br /> /-lr�;S - O j00 <br />