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SIGN FERidIT APPLICATION <br />SUBMIT PVIDENCE TIIA1' EQUIPMENT <br />CO'.9PLIL•'S [9ITEi 1'IiE STANDA$DS OF <br />AN F�FPF20VT:D T�STING LI1IIOItATORY. <br />INSP�C7'ION OF SIGN REQUII2ED <br />BEFORL �RECTION. <br />CALL 259-8745 FOR INSPECTIODI. <br />Application Date �/ / >- / ; . <br />, - ---- (�' B7�-nr3'"r �'C��/S � <br />,- ,. , ��� � <br />F�DDRGSS _7.._ �n..,i� ji�',1 i ✓.r:'. - ,j�[ ;; <br />Tl:e u 'gned owner hereby agr�ees to hold and save harmless the <br />City of Lvcrett from any and all claims for damages i:hat may arise <br />because of installation of the improvement hereto applied for, and <br />further agrees to remove same upon noL-ice from the City and to re- <br />p7ace all public property damaged thereby. � <br />,�. <br />. VALUE: -, l,j = <br />CIRC[IITS: <br />FEE: <br />ELECTRICAL: <br />TOTAL.•FEES: <br />�`'� 2 2 �Q�' <br />�^ � � , c . <br />� i �f � �� <br />; C� �� �. <br />G_ w��'�.. � t� <br />Signed - - �,_;�- % / _ . <br />. . _. <br />Contractor .� . ,:��>�,`' `� � � 3C,eS'— E>24 z.� <br />License No. �� � <br />