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, � , , , ._SICti PLiIMIT AFPLICATIOi� <br /> SUCMIT CVIDEt7CE T11AT LQUIC�1EhT , � , <br /> , C0�(PLTES FIITfI T1iE SThtlDA2DS OF ' � <br /> AN APPROVED TESTIGG LA60RATORY ' ' . <br /> IttSPF.CTION OF SIGt� RLQUIRED • • ; <br /> BEFORE tiFF.CLIG,J. • ' � � , <br /> Cf�LL 259-8745 POR IWSPECTION. • � <br /> /� <br /> APPLZCATION DI'.TE /' — � � � � <br /> ADDRCSS �, �C' / �iL.-li(—l�'�i-`'�/ /'�L``'J ' ' <br /> • ' ' � . <br /> Tfie undcrsi�ned ovner•hereby agrecs to hold and save harmless the <br /> . City of Evecete irom any and all clains for darages that oay arise . <br /> . � •Lecause ot inc[allation of thc inprovement hcreto applied for, and • <br /> . . � furtiier a�rees tn rer.ove sa�e upon notzte fro;� Che City ta and to re- <br /> • place all puUlic preper[y damaged thereby. _ <br /> • ' • VALUB: ' ��l(�/� Gi . <br /> CIRCUITS: S � <br /> � . . � <br /> . • FEE: .� � <br /> ,. �jri <br /> . • ELECTRIGIL: �J � <br /> G <br /> . ' TOTAL FEES: �1 � � ' � <br /> � <br /> : . . , ��fJ� . :. • . � . _ . . <br /> . . �7�/�Gifi=L7 � • <br /> . � �. . . � . . ��� �f ,��� <br /> . . . . � <br /> . . � . . . � . . . � <br /> , <br /> . . . . ; <br /> jl«�f� ' TJ/�� � rC�:-.c;� aaNsa ' � . � . <br /> • SICNED • : i <br /> ,�/ . � v� �/ � � . <br /> CONTRACTOR /!� GL� ��t�%`-� S� --C-tGc'���' �t-E� . • . <br /> • ' LICENSE h0. %��D��r i�-i�/ci ��S�c `� � . ' . . <br /> ' '_/��L// `�(��Z- p . ' ' ' . • <br /> I <br />