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0 <br />S1Gii i'FG."f17 AFi 1.i�.Ai:i�.• <br />SUf3hfT7 (:�tUC`rr.f: ���',T E�.:'i'IP[�it'.IT <br />CONPLIF.S L�TTII TIiL STA?:i�'u"�.DS OF <br />AN API'P.UVED TESTItCG LABORAT03Y <br />.NSPECTTON OF SICN RGQtJIRGD <br />BEFOP,E GRECTION. <br />CALL 259-8745 FOR INSPL•'CTION. <br />ADDRESS <br />AYPLICATION DATE _ <br />c� c r �'�' � �� <br />3-7 r-� C <br />The undersigned owner hereby agrecs to hold ar.d save harmless the <br />Cit:y of Evere[t from any and all claims for damages that may arise <br />because of installatior, of the improvement hezeto appli.ed for, and <br />further agrees [o remove same upon notice from the Ci[y to and to re- <br />place all public ��;cperty danaged therr_by. <br />/ 'C �� <br />VALUE : C � ' � � <br />CIRCUITS: / <br />. �'�/-(/." Cv�'C <br />_�, z: �-v <br />i <br />u� /�-�''� /L <br />FEE: <br />ELECfRICA1.: Y� `> <br />TOTAL FEES: <br />/��-^—Y �' i 1- G �if ' <br />/ <br />����/,�`� ���� <br />S�GNED __ ' CKt� OS7NER <br />CONfRACfOR S � S �t'�',7 �� <br />LICENSE N0. <br />�. � <br />