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<br /> xC'�7 AnPlication Fcr �- �-�- -
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<br /> [�H PUBLIC W�DR#C� PERMIT '"`�°��„_�`° 5----
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<br /> > y� TO POSTING �� z �_ `�'-- E�r,.,,� ,.��,. s ����"'—
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<br /> � O� Owne� IAadmgA7tlress CiD/ 7_ip Phone
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<br /> ri LTl Applir.2nt t.ta�l:nu .ldd�css Cii}' Z�p Phone
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<br /> ,�y H� Descnhe Proposed Wc,rk —1-4-W--��-f�-��-�--,�Jl�k-�J�lr���Q- �7f 3 C��CG-JCi��--
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<br /> y O p� Pro�ect Atldress fil knownl --- -- —
<br /> Attach four ld) ccpies o� p�ans�a. pronoseC vro�k � Ui.�c r: , ni•• and n�te inr fclloWinq as aCphc�Ul� �
<br /> ' c �roperty Lines • Cenledine ol 5tree1 �
<br /> . • Ouihne and dim�:nSi0n5 of rli �.�st��iq and • Intlica�e NoCh
<br /> p:oposetl r'rucmre5 on�he Inl • Show any proposed 9radinq changes
<br /> • Exisbn9 and proposeA WdiUrs • Sho�n �neasuremenls /M
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<br /> ��� PERIAIT CONDI7!ONS
<br /> 1.All Calls lor insft���on shaii:�e m;de 24 hrs.m ativarce-phone 259•BSl Q �
<br /> 2.All work shall b^.peAormed in accordcnce with this permit 7nd curr�n�City o� E:cret!Gesign and Cc-Siruction
<br /> �� Standards and fpecilications.
<br /> s 3.Call L:,cat¢n Untlerground Service 49 hrs.bebre you diy.TOLL FREE NUMBFR 1-800•424•5555. s�
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<br /> ACKNOWLEDGEtdENT OF CONDITIONS
<br /> _ � � _ i ho und�asi4��e-I o�n�ner/apphcant hureby a�7rees Io hold and save harm�
<br /> '�" 7��—� / — — le,c ihi� City ul Eveint� hom any and �i cla��ms lor damages, cosis.
<br /> nx�enses. m causes of ar.;�on that may ari � 2ausa ol ,nstallabon
<br /> �, .�/, � � . _..� _ � antl mainl.nancc ol tlie improvement or oll n+ . .7hPol�naY use heretu �
<br /> ��c _ _ _ � '�, '•�� apphed foi and lur,hei nqrees lo reinove me i�po�� nohce (rom ihe
<br /> Approvejr ConslNction ���� Cily and ,reP��r,e puhlic proPer�y dama9ec thereby.
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<br /> FI L INSP[CTION ����� U t� . - .�-���' ' . �� � .J J C
<br /> ApProved as Consiruc!ad Si, ��.ture ol P.PPiican� Daie
<br /> WORH AUTHORIZ.ED BY THIS PERMIT MUST BE STARiED WITHIIJ
<br /> rvet•tt PUBLICWORKSDFPARTMENi 180 D�YS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO
<br /> 3200CedarSireet BE DILIGGNTLV PURSUED TO COMPLETION. THIS PERMI7 MAI' RE
<br /> E+ertiC W�9FJ201 CANC[LLED BY THE CITY UPON ANY STOPPAGE OF WOHK ON 1 HIS
<br /> ` � ?hone:259-8Yi0 PRpJ[CT OVER 90 DAVS DURATION. .
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