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d <br />a <br />SICN P'.:IiPtIT Al'PLICATION <br />SUfS?SIT F.VIDIiNCE TI1:1T IiQUIP:ll:NL <br />CObSPL7IiS WITtI Tllli :,T.�ND��RDS OF <br />At7 APPROVED 'ftiSTING L•1E�Z��Tn"� <br />II75PECCIOt: OF SIGt7 REQU1RtiD <br />BEFORE ERt.CPI0:7. <br />CALL 259-S7G5 POR INSPLCTION. <br />APPI.IGITION D.'+"tB <br />ADDRIiSS %•-` <br />�o �y s c;� vc��vs <br />The undersi�ned c•.sncr Lereby a�rces to ho1J and save harmle�s the <br />City of EveretC from any �nd al.l clnic�s for damir.�s ti,al' may arisc <br />because oi inst�llaCion of the i;:�provement hcreto applicJ for, and <br />further agrees to remove same upen noCice from the Ciey Co.nnd co re- <br />pl�cc all public p:uperc_: darta�cd Chcreb_�. r <br />VALUE: __ /.7<:. - <br />CIFCUITS: --- <br />FEC: � <br />ELECTRIC:IL: �__— <br />� , � , <br />TOTAL F6L• S : � � �' ` <br />✓,� ��. <br />-.� �; `. <br />' , .. •an�� <br />, �.v <br />. ,7 �:` �_� �.. .� <br />... i <br />J_��' <br />�,�' . . ,,``�- <br />; � � r . ,,. �:;:`� I <br />i • _ �. <br />� � i <br />i�•` ,� �j <br />. � <br />� �, '��ti ����i� <br />% J c�) j �t�el: <br />SIGNED � ��1�� � u��'� g <br />(/ <br />co;;r..�cror. `'— _. --._ <br />i.ictt;se ro. — _ <br />� <br />