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SL`RHIT EVIDENCE TPgT EQUIP::EhT <br />COMPLIES WITH THE 9MN: v,TRLS OF <br />.-_--.... Ati.AL'PPJ`siF.D-TESTI,:G-L-.4SCP1'P(i^,Y•--_--..----- -'- -- <br />INSPECTION OF SIGN REQUIRED <br />DEFOR t nCTI0:7. <br />CALL 259-045 FOR INSPECTION. <br />AP2LIC1al0N DATL <br />ADDRESS <br />The undersigned ow:,er hereby agrees to hold and save harmless the <br />City of Everett from any and all claims for damages that noy arise• <br />because of installation of the improvement hereto applied for, and <br />further agrees to remove sane upon notice from the City to•and to re- <br />place all public property damaged thereby. <br />VALUE: c <br />'✓4yT I �� %``�� T�J ��� r j CIRCUITS: <br />FEE: <br />ELECTRICAL:• <br />TOTAL FEES: <br />iSF�dre �./ - � •� . <br />RIM <br />f . SIG:.2D ✓ .i�j /w 1 OW Ta <br />CC:trRACIOR -_ZjFA- T/4 t <br />IN <br />01 <br />