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:_a.' <br /> SIGld PGRh1IT 1�PPLICI�TION ' � �� � <br /> SUBMIT �VIDENC� Tll?;T ��UIPMENT " /���s �� <br /> COt9PLIES WITEi TIIE STI�NDARDS OF <br /> AI� APPROVED TE>TING LABORATORY. <br /> INSP�CTION OI' SIGN F2EOUIItED / �///� <br /> BEPOIt� �RECTION. <br /> CALL 259-87�5 POR INSPECTION. <br /> Application Date �� /�j7� <br /> ADDRESS 5 O ` 9 �//F_2 Gr1'L�6.� G(//��1 <br /> The undersigned o�•:ner hereby agrees to hold and save harmless the <br /> City of Everett from any and all clair�s for damages that may arise <br /> hecause of installation of the improvement hereto applied for, and <br /> further agrees to remove same upon notice from the City and to re- <br /> place all public property damaged there� <br /> VALUE: Z �t90 � <br /> CIRCUITS: � �l <br /> . � <br /> , FEE: I �� O V <br /> ' �LECTRICAL: � • � � <br /> TOTAL FEES : � �• �G <br /> �j-yE��(- � 1'71 A-1 �.1.TA.1 N O�-1 E� S/�- �[_ELr <br /> . � S 1 Fs�a � 9-i.�. � 17� �L�G_.i . 80 c.�� <br /> S.ILa-1� �'�f� G�� �! Cr�1�. . <br /> � <br /> n <br /> : <br /> u <br /> � � it! '� �.c� �c,c�Lfs d� / �',s 2 <br /> � �, ��� I?,.� (.�.��r� <br /> � a <br /> r <br /> � <br /> ,v \ <br /> .\ <br /> � <br /> � � Signed � ��. ,.�"�,�_�� ��gE,¢2T-� Owner <br /> �j��" �Contractor TUt3C—A-2T DlSr-ZfLyS� �u� �1 - ecn- .SyZ- 28s�� <br /> l; . - <br /> ,� � License No. �3� S7 <br /> � „ <br />