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<br /> �"�V � Describe Proposed Work �5���1�H_..�/./j�-
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<br /> � �C''7 Prolect Address 1i1 knownl _, zZ �. ` N' `�l� ���r����" — —_--.— �
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<br /> y �� Attach four(4) copies ol plans lor proposetl work-Draw b scale anA note�he followin9 as aGPlicah���: �
<br /> • Proper�y Lines • C�nlerline ol sireet �1�
<br /> • Oulline and tlimens!ons o�all eais;m9 and • Indicate Norih �f�
<br /> proposed slructures nn thg Ipt • Sho:v any proposetl 9�a[;u,,7 rhanqc_
<br /> i Ezis�Ing and prcuosu�: .:bliiie� • Sl�r":: me:_-urnme��,�c �
<br /> DO N01 IVRITE �ELOW THIS LINE ��
<br /> 6 �` '�� PERA4IT CONDITIONS
<br /> _� :_,,, 1.All calls�or inspect�un shan b ni �,e 2a i� ; in.�tl�nnce pnone 259 8810 r��
<br /> 2.All work Shall be pario�med m ��.r�1ni �,�nh Ihc,r'�"���������<urr_n�C�y r.;[ �-o.r.!['.s�qn r�nd Consiruciion
<br /> Standards and Specificatioo-.:.
<br /> �� ���s1 3.Call Location Under�ww:d � in�.:�-:�'� � i ',,. , ��.�a�u TOLL FREE NUMBER 1-800�424-SSSS. �
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<br /> less �he CAy ot [veietl from any and ell C.taims loi dumapes, cos15
<br /> ' ' j��'y�� expenses. or causes of action lhat may arise because of inslallation
<br /> � (� �.�/� L� / _�_ and maintenance ol Ihe improvement or other ri9ht-ol-w�y use heielo
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<br /> applied for and luriher a9rees to iumov�� r�anie upun no�ice liom Ihe
<br /> Approv�ed I r-Conslructlon Date G�q"hna�Io rqpla�qpub6c oropai� �dain.�,�mJ Ihui����y
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<br /> FIN�INS� CTIO —� �� �^� Datc - � V � ------
<br /> Appro�ed as Congtructed Si9na�ure ol ap icnnl ��+��
<br /> WORK AUTHORIZED BY THIS PEHA1IT MUSI �E STARIP.D WITHIN
<br /> cvcretl PUBUCWORKSDEPARTMENT 180 DAYS OF �ATE PERMiT IS ISSUED l�ND TH[REAFT[fl IS 70
<br /> � 3200 Cetlar Slreei BE DILIGENTLY PURSUED TO COMPLETION. THIS FERti11T t.1AY 6[
<br /> Evnrell VY�9H2O1 CANCGLLED BY TI�iE CITY UPON ANV STGPPFlGE OF VJORK ON TI IIS
<br /> Phone-�`,:i��R1U � I'Gi�ICCT UVCf; �i0 DAY$ DUR;L[)fJ
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