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SIGI� PPRt•tIT APPLICATION <br />SUGI4IT EVIDP.idCE 'Pf1AT .P�UIPIdPN7.' <br />COI,PLITIS PI].T❑ TIiE S'fA1dDARDS OL' <br />A?� APPROVED 'L'GSTIt:G I,ABORATORY. <br />I1iSPI;CTION Ol? SIGt1 R�nUIRtiD <br />IIEFOHP li12LCTTON. <br />CALL 259-E3745 iOP 3.^IS]11iC'PION. <br />npplicat.i-on Date [�A�1� <br />AUDRI:SS �Q�____� \���"i'ML�-������--. -- <br />The under.signed o�•:ncr hereby agrces to hol.d and save ha,;nless the <br />City oi Iiverett from any and al]. c.lai�as for dam�i�7es that may arisc <br />because of i.nstallation of the improvemcnt hereto appli.ed for, and <br />further agrees to removc sar,e uron not:ice f:t:om thc City and to ro- <br />place all public property dar.iaged ther.eby. <br />V�1LUE: �GipP�� _ <br />CIRCUITS: �j � _ <br />F�L: �• �J� <br />I'sLTCTRICAL: <br />� �JCp.� <br />�'- � � <br />�/ c- >� a!� 1 ( <br />lN��. "-��}=rt+.�`-- ' %(°"1y77 <br />TOTI�L rLrs: <br />� � v <br />Signed (,i/ia.l \� �Z �� Gt'T�i1 _hl(o ���(Lia�i�L <br />Coni:r��ct�r �+ti^� Slbhi (.Q t1�U ' <br />License No. �F Zs1� -G� 3 - <br />Owncr <br />