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i <br />SIGid 1'LRI•7T'i' I,P1'LICATIOIZ <br />SU�MI'i' T.;VIDS1dCi: '19111T P,QUIPf.];P7T <br />CO:,PLII:S S4I1'!i Tiii: STA[dUA12D;i OP • <br />1�t7 APPRO��I;p 2'IiS'PING LAL'OItATORY. <br />It7SPLCT:CON Or SIGid REQUII.2ED <br />�ii:roFu; �.r.rc�rzoi�. <br />C]:LL 259--0745 1'GR IPISPECI'ION. ' <br />0 <br />. <br />' ApplicaL-i.on Date �� ��h� <br />—i f–�— <br />t,rn�ss i20 i F (%F/� �,PC1=/V �rJ,�Jy <br />The undersigned oomer her.eby agrees to hold and save harmless the <br />City of Lver.e{�t- irom any and all clair,is ior damages that may arise <br />because of .insta].lation of i:he impr.ovement he�- •Lo appl.ied for, and <br />fu*t-her agxees to remove same upon natice irom :.hG City and i�o re- <br />place all.� puUlic propert-�� car•.�aged thereby. <br />. . . � VALUE: � Q�s��- � -_ <br />, .. . . -,: CIRCUITS: �1 <br />.. �.' , <br />. ;�.: . ..' , � .. �r�E: . ' ' . <br />� . ., . . �L�CTRICAL: . <br />. TOTAL•T�ES: <br />{-' - - �� �—� <br />I •. � • ' <br />. . _ ` � ' .' . . . <br />, � ��. ... . /'' <br />I' ' 1 . <br />� <br />/ <br />� . ., � <br />! . .. <br />., <br />. . -��.5- � � ' <br />. o �� <br />. �. <br />_''�� Signed ' _%/F�� �-/C��i� . �y/�P{�� - �'' �� ' //�' Qwner ' <br />� � 7 <br />1'�: 'contrac�or � f1�"N=C�-'�iT.� � /t`�✓ . -- <br />c� Liccnse Pdo. ��' `nZ —.52C{g-/�d — �c�% . <br />�, • <br />,� , , . <br />� <br />� <br />li <br />