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tit* of st6cKtON <br /> WAA M W OF PUdllt W17M <br /> APPIICAtION Fal! PNtRdACHMM ON PUBl1C 1101-It-oF-WAY <br /> _ N° 61066 <br /> (�- VVI ttirnL t'�s'J i� bat� 7 �• <br /> rw� enFree r � pherie�i r <br /> Addra� t9. <br /> t*MIM of 146"tW wark,if!_,�i?Q'rr��- AF'Pkt7Vbt3r btkECtaR of PUBLIC WORKS <br /> OenftXbnf060*Addriis <br /> Allmofld werlinq Doli_ —�d-gam C6rhplifloA #tole..—!_-3 ~�¢� _Permil E„pirofion Dalt <br /> I (or We) hereby apply I& dh ehcrdachmenf pbrmlf to tarry out the following work:_ OI X <br /> V <br /> TM etfavl nsd,id 60011tolif M46y#44tfi01 jAlr"I iibn le- POW FEE................................................ t <br /> Additlonol reofap& <br /> ltwer top bapoM ...............-................... <br /> TOTAL DEPOSIT ........................ _ <br /> 13uilding Permit No. <br /> Improvement Plan No. <br /> 9upplementai Cohdilionm <br /> 7- Sir r� <br /> Sher+iltvA irbbvi dr Mir fb drd*lnd iubrnifl�d <br /> IMPMANT. Appliedrff hereby b}tral fa tdrhply with all prtldliltflil of this permit of well as all applicable City ordinances, <br /> rblbtutioni, sla"clatds and spAcilleaHehf tWrehfly th effect, drid to pdy to City IN actual cost for removal and proper replace- <br /> fh#ht of any ifarii Whlf h drdel "' hieef above# tb4utrbrhetl11- Pallure fb cdthply will be cause for revocation of permit. Appli- <br /> canf agrees fa lndIMhIlY and held fhb 01y hatii•ileli dgdihlf dr~y dlid del 1e1sel, edsfs, or domdges resulting from injury to <br /> persons, death of pbribm dr ddMage fa PtdoatlY 6'':cutrin] df 114 ilea of br tis d result o1 work fb be performed under this <br /> permit. Certificate of Irflufahte *111 be presenfed by dpplitnhf updh re uest. <br /> Alii GNNHI NVfI11160 f 8h MMer66 Will at lN1A pbNll WWI Mi'Aqul�bfnlltl 6f rtefll1CAtlon!And lnep4etfene. <br /> Permll l:r�Ini�rllAlp�t�r <br /> A4�-R3R8 Signid, Phone <br /> lit—P.rmlite* tad--$itt Ird-ilnenei Alrr—uhlirr/droit <br />