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. SICN PL•RT1IT A?PLICATION <br /> SUEMTT LVIDENCE THAT EQUIPt3.`IT <br /> COMPLIES WITH Tt1H STANDARDS OF <br /> AN APPROVED TESTING LABO:tATORY <br /> INSPECTION OF SIGN REQUIRED ' <br /> SEFORE ERECTIDN• <br /> ChiJ. 259-5745 FOR INSPECTION. <br /> ' pPPLICATION DATE � — <br /> ADDRESS I��C �' I�I�1 �1� � <br /> ' The undersigned cwner•heceby a�;rees to hold and save haroless the <br /> Cit� of Evcrett from any and all claims for damages tl�liedaforriand <br /> because of installation of the inprovement hereto app . <br /> � further agrees to removc sane upon notice from the C3[y tu and ao re- <br /> place all puUlic preper[y damaged ciiereby. , � <br /> VALUE: /� �" <br /> CIitCllIT S: <br /> FEE: � = <br /> ' EtECTRICAI.: � �`�' <br /> . � <br /> TOTAL FEES: /� <br /> � 1 � , s �-,;t u- � /Z���,� .�(c�� <br /> . ��-�Sr��✓�- I � � � � <br /> ���� �c�-�I�� r,� �� <br /> � � � . <br /> � - � , � ( �� CL-U.��c-��u- ?�'�/��- <br /> �,�,�'``� <br /> �' / .t�-J �,"r"`�(�! � , � l � , � � � ' ' <br /> G i � <br /> ��� <br /> � ��/ <br /> � � OWNER <br /> • SIGNED <br /> COYYlt1+CTOR - / GU S " �'� `� � � � <br /> . LICENSE t�0. , �i �? �- �? 3 „ . <br /> . 'i ��'.� Ti) _%'-_. (�.�-.. ���. � <br /> � <br />