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s: <br />:i , <br />:,IGN PliRbIIT APYL.CCA`1'ION <br />SUF:t4ST TVIDP•.NC� TI1A7' )iQUIPi�1L•'NT <br />C0:4PLIES WITII TIIE ST]�NDI�RDS OP • <br />AN APPROJliD T�STII4G 7,A7302tF1'1'ORY. <br />zt;sn�cTzora or SIGN �Lc�vzru:n <br />n�Yoru; LxLczzoN. <br />ChT,7, 259-II745 1�OR INSPECTION. ' <br />'r��i y�71 <br />3�i� . <br />�y1 y �'_� ��'�"", <br />� Application Date �C� %.Cf <br />n�Dr�ss iS �9 �'/r�2G•2F,�-iV %J/�Y . <br />The undersigned owner. herel�y agrces to hold and save harmless i:tie <br />City ci rverei:t fr.om any and all clair:is for damages thai may arise <br />because of installaL-ion of- the improvcrnent her.eto applied for, and <br />furt.her. agrees to remove sarne upon noL•ice from the, City ��nd i.o re- <br />place all�public propertp damaged thereby. <br />- - • ' .� � VALUE: �� ��y . <br />' ,., -. CIRCUITS: _ % <br />, ...�;'` <br />• ;t.: - :' '. .,' F�S: �'J� � U . ._. <br />� . . � ,.., - . �LECTRICAL: .� . OU ... , . <br />. . � 'POT.�I, • F�ES : �`� I +`I- , U G . <br />.,I.•: ' . . . <br />0 <br />i ' <br />� � ._ � �`�� �:?. �/': _ ,: <br />. . . i��i,�--(-�, , .. . `C� <br />.. �. C. ; <br />�%O �� f�iyp.J O� S�4 � 7D lj°,�r�lr <br />o��• 6�l • � I o� va.�-y 7 � <br />� Signed ,�I --iC /TE '��/,�[L(/� _��J'��� Owner . <br />�� Cont:racto�- �{ / ' � "`/V� <br />N\ /�/�-[/'�/ i�� J�f��t5 ITHc.. � <br />� ' _ <br />License No. - 5��/�s %�� �6 62- <br />�G • � . .. <br />0 <br />� <br />'7 ,�f i' i i1 <br />� <br />:� <br />