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Daie_4=h-�G
<br />Appiiwtion For
<br />PUBLIC WORKS PERM17
<br />F'nnl or Typ�� Oniy
<br />l.oren `I��rrisscv 21 IlSlli St tih; Gvurctt W,A 9N208 "153-2162
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<br />Iilue Rihbon S[eel Bl.dg I704-A .\nderson Rd Mt Vcrnon 9N273 424-901G
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<br />li„�;cnbeProP��edWork neW gnra�e -----
<br />ri i� rt nddress Ul knownl 21 I l5th St _ SF. _. _
<br />;di ,. n �� ��ir �Ai cppir5 0l F.ns lor proposed work �[)�a:, f• .-� ,i ����f 'i. �.� .�n• lollowm9 es BPVl�cahh�
<br />,1 �'rupei�Y Lmus • Cr�nlerlin� nl S�ree�
<br />•� tUltine lnd dnnrns�nn�, nr nP r�.rJ.,�,� .�n�l •��.dir.�lr IJnrth
<br />r �pbsrd S�rur'IUn,�. on It•r b.� •"�nv. Bny� pr<ipuarrl �P i�1.,.� � ry:ln.P�.,
<br />��I�.i .i-��� dnrl P�npar�rd i.Ph�n��, • b�in�� m�•J�un.ini,nl5
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<br />1'FH�".II GONDI1lON5
<br />I:dl rnlls lor insper hon sh,�ll Lu m3de 24 hrs. in advanCe � PhOne ZrJ9•881 �
<br />,� M'r:rnM Sh;ill be p�•i�oiinr'd in .�rcold.lnce Wi�h Ilvs permd And cunPn� Cdy u� Fo-r•�r�� Drsiqn anU ConSlruCion
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<br />� i�,dl l n� .�'inn Uni1���iP��urn1 6� .i �� �1H nr�, 1��•Itn�� y�u diq TOLL FREE NUMBER i•800•�i24•�J�J$rJ.
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<br />�� � i'UI�UC WORKS OEPARTMENi
<br />�,*� { �700 Cedor Streel
<br />��� i .�.relt WA!1P701
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<br />., ,��.1.,�. �.���i.,v.��ri�dP{rliranlhorehyagieaSlohMdandsnveh:rn,
<br />�. . ,,,, „ � i.��rcll Irom any anA all daims loi damapes. ���-�+!�
<br />��y�.e��!su�. ��� causcs o� aclion Ihat mny anse ber.nusr o� in5ta�lil������
<br />anA maintenanr.e ol Ihe �mprovement or other nght�nt�µ��+y u•:�� ���•��'I��
<br />epPheA io• and lurther egrees to remove sume uP��r� "�'�"' �""^ tr,�,
<br />Glv ����1 to rnplace public p�oPerty damaged thereby
<br />Siyn;ttui9 0l Applieant---- -- -� �- ��D.11e ��
<br />WORK AUTHORIZED BY iH15 PERMIT MU57 BE STARTED WITHiN
<br />180 �AVS OF DATE PERMIiIS ISSUED AND THEREAFTERIS TC�
<br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PEAMIT MAV BL
<br />C�NCFLLEU BY iNE CITV UPOIJ ANY STOPPAGE OF WORK ON 1N15
<br />1���� ifCT t7vCta>U LanVS DU�nTiON
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