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SIGN P�RMTT IIPPLIC7�TION <br />svct�zT r•.vrnr•.hc� T�inT .rnorPr�rN�r <br />C0;4PLIE5 {•1ITII TH� STAND.�R�S 01' <br />A?7 APP1tOVPD T�STING LAI30i:ATORY. <br />IIiSPLCTTON OI' SIGN ItliQUIItED <br />IIEI'ORl; L•'RPCTION. <br />CALL 259-6795 rOR IP]SPECTION. <br />ADDRGSS <br />%�� 3� �7 � <br />� L�/ <br />I�pplication Date �i y � i % <br />The undersigncd otaner hereby agrees to hold and save harmless thc <br />City of ]iverett irom any and all clair.�s for damages that may arisc <br />because of- installation of the improvement hereto appli-ed for, and <br />furlher agr.ces to remove same upon notice from the Ciiy and to re- <br />place all public property dar.iaycd therei�y., <br />VALUE: _����� � <br />CIRCUITS: <br />r��: <br />TOTAL r�Ls: <br />�ti�. �l�l � �i`�12-I' (�1- ��/� � `;' �����✓ <br />�v� ��1�-- . <br />�—�jo-72 ��e� <br />�/ 5 �/ 7-i K. c. — s•`:= r-i.� �:=. �zL. c: a��, � c� <br />i2�, W u� i2� r�r-l"l' S. <br />Signed <br />f� <br />Contractor � � /vt �{} "S� (�' iv' �2! r J /�/C-- � <br />7 ,' <br />License ido. G � 7i )'.J <br />f"=a (Z� fZ�i i s f r�l� <br />Owner <br />