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I�urm No. l�f. /'� /�) � � <br />f � / � � � f' iPIIcntlnn �n... ..... <br />.� .... ............."-:..... �J.�,��ja/, ,�,� <br />.. <br />. , L/� . <br />'� " � t:�•o����cc.... T ................iso.� <br />�Tp,7'}�F. Sl1PIiR1\TR\DPNT OF TIIR R\'P;RF.TT �PATPft CO\IPANI': � � � � � � � � � <br />;' I'liq/•ehy apply for the use of �cnter in necm•dnnee w�itli Ihe ndr,s nnd regnlntimu nf q�o I:crrptt N�tter Compnny, :tnd reqm�xt <br />�� thnCd��✓Ij/., inch taP he inserti�d In the mu(n nt qie �ilnre abo��e stntcil. � <br />The Ph�mbnr who tvifi do mp worl; Is....... ......................... �. , <br />../^� .. ................................ ............. <br />The owner a[ thu premises is............�. ./•.. ..... .,� / . <br />.. ..................:.\./... .,.............................�.... .. <br />, y <br />The n[:ent Is .................... .............. �� ' <br />.... .... .. ................................ ............. <br />..../..'.+././�.///.�/ <br />Thc [ennnt is ...................... .......... .... vC�(�("i .......... • <br />�ti <br />. . . . ... :............... ........:....................... ............. <br />� Tl�.c �vnter rcnt shnul�l be ehnrKeil to .................... �.�............. <br />� ,�f� ........................ <br />... <br />� SIF�rcd. .../ �.... .i... O7�Q�/ \ <br />.. ............. ...l.....................\ <br />`(9a Uther Side). A,'pllennt. <br />