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I <br /> l lrifia Oilswirl Permit Number: <br /> 1:it 01:1 118 l; r7 i,ii, Field Paving Foi'iift <br /> ,,irrti d Permit Expiration Date: <br /> Date: _ , "%7-/S Street Address: 505-2- 9,42T Aci e <br /> Foreman Name: t/ZF,-1 MaAeA)6 Cross Street: AA, � �F�-✓e <br /> PM Nrarnher: 3 fl L(q53 city oirsaty: <br /> Concrete W x L. Depth <br /> Roadvray —inches <br /> Sidewalk inches Color Y/N Aggregate:Y I N I Decorative/Stamped:Y I N <br /> Sidevialk _inches Color.Y I N Aggregate:Y!N l DecorativelStamped:Y/N <br /> Driverray _inches Color:Y!N I Aggregate:Y/N I Decorative/Stamped:Y/N <br /> Driveway —inches Color:Y!N I Aggregate:Y I N DecorativelStamped:Y/N <br /> Curb Ramp Domes:.Y!N <br /> Curb If Gutter:Y/N <br /> i <br /> Valley Gutter If <br /> Dovrels ea Size:#4 145 <br /> Asphali: W x L Depth Adjust/Replace <br /> As j' T inches Manhole Frame ea <br /> inches Sidewalk Gas Valve Box ea <br /> Aspha oncrete Combo <br /> over—° Secondary Electrical Box ea 13'x 24'l 1 i"x 30' 24°x 36" j <br /> Grind _inches Valve Frame ea 15' 123' i <br /> Asphalt Fabric Valve Cover ea 30'x 30'(32'x 32' 48'x 48' <br /> Asphalt Berm/Curb if <br /> i <br /> Saw Cut Depth <br /> Other W x l <br /> Asphalt if _inches Place.Paver!Stone/Brick In Concrete:Y/N <br /> oncrete 52-, If ,�inches Traffic Marker Dots ea Reflective:Y!N ' <br /> Seal W xL. Plug 1 Y2'Gas Prospect Hole ea Concrete Asphalt <br /> Slurry 1 Fog!Sand <br /> Striping Width Notes <br /> Paint If _inches <br /> Thermoplastic If —inches 1 <br /> Traffic Legend ea <br /> Double Center Lane If <br /> i <br /> 3M'Scolch Lane' If 4'18'112'.Crosswalk I <br /> �A LL AVe, <br /> 9' <br /> til �osZ i <br /> l� <br /> 3�� I <br />