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�-------- _.___ _ . <br />tSUBMIT F.VID�NCE TIIAT �QUIP\1GN'i <br />GOn1PLII?S �1'1T1I 1'1IL STANllARllS OI' <br />TI-IL UNUL.121V121'fL•'125' LAL'O12ATORY. <br />IA`SPLCTION OF SIGN 12LQUI1trD <br />B�FORE ERP:CTION. <br />GALL Z59-87•}5 FOR INSYL•'CTION. <br />Datc �/j ���� �. <br />i��i C�cp,Tc. <br />APPLICATION P'OR C�i�N '� �1��-�l�v �?-�l`"= � I_O�\.,S <br />Thc undersigned owner hereby agrecs to hold and savc harmless the City <br />of Lvereit from any and all claims for damages that may arise because of <br />installation of the improvement hereto applicd for, and further agrces to <br />re�riove same upon notice fro�n the CiYy and to replace all public property <br />dacnat;ed tliereby. � �) ` <br />/ �� VALUE�[p`�,pQ � <br />� GIRCUITS: � <br />Cts�r��T�+Sz�c� <br />3�l 3 <br />2��z <br />s...; �r� ( p, j <br />+�...: .. z •= >- <br />�� t,:. ;4 <br />�'---� <br />- _— -._.�_�.�._.,._._... ._.. -- <br />__ ��c�F�� ��� ---�---•- <br />�?L�c1L�� <br />Signecl � ti�'1��.,_ ���� Owiier <br />�L �j^r- TZ( ��t.,r�,�'�f�� Contractor <br />��.,`�. A��c; H p� C, � � <br />v��/l. �' � S- 22� 7� —��G'duuL�,�S� � c.� y/16-%-t�9z�" 4j-' �z �YrLG> e�L� <br />���� �n �- t �A� <br />� � � Ls'rQ'n�CG � " '-Lc � �7�tC_Cd i-� Il.c[: Q.!-G��C�z��Q� <br />�' � ��� �-�u�7�� �� (C'!� �'i!'��ct,�ct��cu czi�c��t�' u'�w <br />O�ii'�ct� 6 'c?�f-7� c.2t.CCcic�:t-la�. � <br />�. !/.i cr..el.rxti..��. - j � zY-7•. <br />