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bl�[� Y�Ri�fT_T APPLICnTIOtd <br />St1II14IT EVIDENCG TIII\T EnUIP2•SEyT <br />C0:4PLIES S4ITII i(]L�' STI�idDARDS OF • <br />AN APPROVL•'D iP.STING I,l�IIORFITORY. <br />ZNSP�CTION OP SIGN REQUII2ED <br />F3F.FORE EP.GCTION. . <br />CTiLL 259-E3745 I'OR INSP�CTION � <br />• • � <br />' � , /z�/%3/77 <br />• 3 7/� • <br />. � • A li t' D t /� ��U �� /�%� <br />pp ca ion a e „ ,• <br />. � l/i�rt7�C�3iJ �?:fc� 70j�1%� L� .. <br />ADDR�SS . ' C/ �L %!/�.'�!'E: c �c/ GL�" <br />The underaigned owner hereby agrees to hold and save harmless t}:e <br />City of L•'verett trom any and all claiMs for damages that may arise <br />because oi instal.lation of the imnro��ement hereto ap�lied for, and <br />further agrecs tc remove same upon notice from tiie City and to re- <br />place all pub�ic property dar�aged thereby. <br />, � .��'.� <br />. _ . . � ' • � . • VALUE: �,;�/ a 'E-.�-_ � . . . . <br />� . . • . � ' - �-- <br />. � ' , .::, .., ,•. . -,. CIRCUITS: � : <br />. � ' �� �. . ' •o� , � <br />. � . .;; _ .. .r�E: . , �. <br />T <br />. .'� . . ; ' ':'': `� r ELLCTRICAL: . . . — <br />. . . . TOTAL.•I��ES: <br />e <br />. • I' <br />� � �� ���� . . . ' . , . . <br />• � • � .. .� •I . ' . . . _ ' ' <br />, V• <br />- ' • ' .. . • . .�' . . . ' . ' �.�..C.i�K/._✓__ . ✓i�,�(JVI� /�. 1� <br />' , .. 1 ' . . . I ♦ ! �.�� . ..�` <br />N <br />' . .. . • . . . : • • • ... ' . .. . . �•��•� (� :`� ��•� . 9i <br />. . . .. . .� ��•13�/'��J - <br />. ., . . E=d,2�ii �.�ir/ :�/��%/r����-/�. .�-/� � <br />/ , <br />5zgned i' > ` �� 1���. �i���',����� Owner . ' <br />� Contractor <br />�� License No. <br />� <br />� <br />: . ' . :' <br />t <br />