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S�PERASIT APPLIC:ITION <br />SUB;IIT EVIUENCE TFL1T EQUIP?SE�T <br />CO�iPLIES WITII TflE STANDARDS 0: <br />AN APPROVED TESTING L4BORATOi:1' <br />INSPECTION OP SIGN REQUIRED <br />IIEFORE ERECTIC�. <br />CALL 259-5745 rOR INSPECTION. <br />nnDr,rss <br />� <br />APPLICATION DATF, ` i �i C� <br />�� �/Oi1,Ynv�u c.n � <br />The undersigned owner.hereby agrecs to hold and save harmless the <br />City of rvcrett from any and all clains for d2mages that may ari.se <br />becausc of installation of the improvement hcreto applied for, and <br />further agrces to remove sane upon notire from the City to and to re- <br />placc all puUiic property damaged thereby. <br />VALUE: ��� t'= <br />CIRCUITS: <br />��Lli U /il <br />FEE: <br />£LECTRIGIL: <br />TOTAL FEES <br />�- �' — <br />���cNpJZ�-�' '�i�lti°i�y S�L„�c,�s .� <br />l��'-c4��rn= i�i2-��v � <br />.-r .Vy,� �'�rr.-%-- <br />� , <br />.' I � � T/� l! � S((�ti��� <br />5 <br />-`�---- ����od��� <br />SEP 2 1 1978 <br />i�1i) i s d:✓ <br />SIG:4ED I i'"7� `�� �L%2— ���"+IIlc�. . ��.✓, c'; �;�tvi-� <br />T �� <br />coxrracror. �/ /���-v .5�����% ���, <br />LICF.N ;E N0. �� %�' I�f� ;'� <br />CI'(Y Of [VERETT <br />insp�c:ion Dept. <br />�-�1 z� `9, C-P <br />F`ce <br />