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StiTs'_^:lIT ��riDL:NCE Tl-L1T EQITIP\f?�NT <br />COr.1�LILS PTI1f? TH� ST.11`iD:',P,DS aF <br />Tf-:L• ii?`:llL'Rt'�i ITERS' L_�L'ORATORY. <br />Ii�'.SP�CTiON OI' SIG.; FEQUIRED <br />BF:� OPii: Tj'R�CTION. <br />CALL 25y-8745 I'OR IlVSP�CTION. <br />!�PPLICATION I'OR _1�� <br />y�.�s/� � <br />Date /��i�-- �b//7s� <br />The undersi,r,ned owuer hureby a�rees to hold and save l�armless the City <br />of i,vcrett irom any and all r_laims :or aamahes t:nat :n�3� a�isa because of <br />ir_stzllr.tion oE the improvement hereLo appiieci fuz•, a::l £urt1:�.•r agrees to <br />remuve same unon notice fr�m the Ciiy aad to r�p'_ace al'_ nuhiic preperty <br />darnaae3 thereby. <br />��!/J�/J <br />�-- <br />���1���.� <br />V.�LU�: ��. �/ - - <br />CIRCUITS: � <br />�- � O � <br />5 i C7 .�f' O�u L.f- <br />itlo j Q.is=�JU1 G <br />; <br />�.IL. �. c. -r%1{'/�a^ <br />� ' V1 - l=�-"' �CG� 7'/TiB�j/� <br />