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_SIGN PL•ItMIT APPLICATION <br />SUBDfIT L4IDCNCE THAT EQUIPMENT <br />CO�fPLif.S WITFI Tll6 STAND.IRPS OF <br />AN APPitOVGD TESTING LABOB.�TORY <br />IP�SPECTION OF SIGN REQUIRED <br />IIEPORE fiRECTION. <br />cnLL 259-5745 r•oa INSPECTION. <br />APPLICATION DATE <br />ADDRESS <br />The undersi�ned ovner•hereby agrees to hold and save harmless the <br />City of Evcretr from any and all clair�s for da•aa,;c s that may arise <br />because of installation of the improvemen[ hereeo applied for. and <br />furthr.r agrces to remove same upon notice from the City to and to re- <br />place all puUlic rreperty damaged thereby. <br />VALUE: Y� � �j'�� , o0 <br />CIRCUITS: � <br />- -, - <br />FEE: '.� . `� '_� <br />ELECfRICAL: ` ` <br />TOTAL FEES: <br />�. � <br />/J/� i � _ .� <br />�. <br />� �r� V�C�"r5 <br />' �;� <br />� <br />�.�,' ; � <br />1� . — <br />1 <br />� SIGNED �%J�L�--��=F= � .�>/1�E/�: ' OWI4ER <br />coi�ancroa ` 1������c �VY�+—`1a4�]" 1%�O� N��I.�o�,-���-����4:��F <br />LTCCNSE N0. I I C� �� �> ' � 5�— b9 00 <br />; ��� ,� �-�I� w ��'cc�na ^x) <br />