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01/25/2006 09:24 3398093 MCBUZ DEVELOPMENT PAGE 01 <br /> 3,1-:k06 12:1r- -rh48813324 STC PERM?TS PAGE 01/03 <br /> AFPLTCXT .ON FOR =Cjtck&CDWT FEii3!'IT <br /> s <br /> TN!ttF <br /> . ..R I ZOO(. OWFAc dw ONLY <br /> 7p; sem Coaquin County <br /> Department Of Nblic Works ?A19x O <br /> EXP, DA <br /> C VALID 0'6 To I I VaaAZvalGlYs: <br /> (7►ppleles <br /> iraut ae) STROT �S�fC� " <br /> mm <br /> (1Aaiung Address) FORMS 3S W <br /> (City, Abate, tip code) <br /> (Area Gods - Te'lepteone Bamber) <br /> one <br /> cn <br /> Sketch (Dstailad plans ens be submitted) r^ N <br /> �'o o D <br /> '79 330 0M <br /> x x O <br /> / $ OC-) <br /> fi r � w ►�, <br /> a `' <br /> d f ei v� iz. 70 C) z <br /> x crt � <br /> 'tho undersigaed hersbV applies fOr, pdrmiaeion to excavate, e t t end/or <br /> nth ae sncroao2t Couriby Ria7xway ]Livbt-of- :oa Ghe aide-of <br /> C-7(-'jaPDro:XLM2telx Q t lm <br /> foll,,wiog pork (deeoripti of W04% <br /> for approwiTrAtelx <br /> work will vv=ftnce an or mbvut <br /> L dsY* <br /> 1, the undorea.gned aertiCY that I sm tba Owner of tha reepeotive grgprortY, or ssh <br /> c,�uuiliiCiwdl ra repxa*ent the ovae7r and agroe to do the work deeeribdd nba'a i:a , <br /> accorda=v with the rules, reegrkilatienls of saw Jaazfxin County and Aubeat W <br /> inspection snd approval. <br /> i tMe of Ap& l flint T'it <br />