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C, <br /> �afV 1 l�' �fd�ciornpaj? Heid Paving Form Permit Number: <br /> Ir_. <br /> -7 <br /> ,' a <br /> Permit Expiration Daae: <br /> Date: ('�-1 ' �L1" Street Address: 3!Cy <br /> 1 <br /> Foreman Name: Cross Street: <br /> PM Number: 14 cityounfy <br /> Concrete W x L Depth "�- <br /> Roadway —inches <br /> Sidewalk —inches Color:Y I N Aggregate:Y/N Decorative/Stamped:Y/N <br /> Sidewalk —inches Color:Y I N Aggregate:Y/N Decorative/Stamped:Y/N <br /> Driveway —inches Color:Y/N ! Aggregafe:Y/N Decorative/Stamped:Y/N <br /> Driveway —inches Color:Y!N Aggregate:Y I N Decorative/Stamped:Y!N <br /> Curb Ramp Domes:Y I N <br /> Curb Mea <br /> " Guffer:Y/N <br /> Valley Gutter <br /> Dowels Size:t,14 1 4'5 <br /> Asphalt W x L Depth Adjust/Replace <br /> Asphalt �inches Manhole Frame . <br /> Mill&Fill ea <br /> inches Sidewalk Gas Valve Box <br /> ea <br /> Asphalt/Concrete Combo —' <br /> Grind over—" <br /> Secondary Electrical Box ea 13"x 24" 17"x 30" 24"x 36" <br /> inches Valve Frame <br /> ------"--- ea 15". 23" <br /> sphaltFabric _ - <br /> Valve Cover ea 30"x 30" 32"x 32"148"x 48" <br /> Asphalt Berm/Curb If <br /> Saw Cut Depth Other <br /> WxL <br /> Asphalt If —inches Place Paver/Stond/Brick <br /> Concrete If _inches Traffic Marker Dots In Concrete:YIN <br /> ea Reflective:Y!N <br /> Slurry/Fog/Sand <br /> Seal W x�' i'(ug 1%"Gas Prospect Hole <br /> P ea Concrete I Asphalt <br /> Striping Width <br /> Notes <br /> Paint If _inches <br /> Thermoplastic If —inches <br /> Traffic Legend ea <br /> Double Center Lane If <br /> 3M"Scotch Lane' If 4"18"112"Crosswalk <br /> L 4, <br /> __ <br />