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MAR-06-2001 09:39 rAMBRIA INC. , 1707 935 ES466333 <br /> .9(� P.02/03 <br /> CITY OF STOC• <br /> DEPARTMENT OF PUB IC WORKS ON • b b 3 3 3 <br /> ASFAPPLICATIONFOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> Gyh�;0.�v�wln��1 Dare <br /> AmJ =r) RFC`EZV-ED <br /> AD <br /> (OplicanYsName �IZ�D I FEB 0 8 2001 <br /> wnerTf <br /> Address Perk\Int S rI 'tft ti Ph.n.70-1-135-4V 6 ,�� <br /> S 4h Yh n. Staee A1 5 APPROVED: PUBLI �1/GFI/.SS DIR_EC7DR <br /> city 21p-/ f t ,r� <br /> Location of Pmpoaed Work,etc. O 13, ^^ G_� r l C <br /> Owned Gontramdr Address Y,/1 C+'Q� 0.\}Dq�,hl�- _ Date <br /> Estlmating Staring Date Max-Ph ry�y _complation Date I Parma F�grlratlon Date �rJ ,.0��` �n <br /> 1(or We) hereby apply for an enroachment permit to carry out the following work: `'�A ,1 - �' Y�"-Yl-+ua•l'�•-� <br /> Pr <br /> RPT PF Af: <br /> 51 l� <br /> B'�MVB nB 19111 h0 fBf♦VB1mIi31 10 I � 00 <br /> �S°FS_.-. -. \� PERMIT FEE..........................................S <br /> Additional Footage Fee...........................; ~ <br /> Sewer Tap Deposit................................. <br /> J TOTAL DEPOSIT.............t <br /> Building Permit No. <br /> Improvement Plan No, <br /> Supplemental Conditions: <br /> (Velk Isut �1e ivts�a( 11, �.c 5ir�tuk7uC. <br /> 2� �r 8nJ dawg4zA 5tr)ew_ll�`4u COS <br /> �{auld(a++.d-6 rar. 4--it- <br /> -S <br /> Zs <br /> -S Coo folyY ;'D <br /> Snow amtcn eocve or rater to arevnng sunmirw I �� nip IaAe- GIO$l}r QS G'fC De�N�� IT CAr <br /> IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit as well as all applicable City ordinances, resolutions, <br /> standards and specifications currently in effect, and to pay to City its actual cost for removal and proper replacement of any item which <br /> does not meet above requirements. Failure to comply will be cause for revocation of permit. Applicant agrees to indemnify and hold the <br /> City harmless against any and all losses, costs, or damages resulting from injury to persons, death of person or damage to property <br /> occuring at the site of, or as a result of, work to be performed under this permit. A certificate of insurance shall be submitted to the City <br /> Risk Manager prior to beginning construction. <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT (1-800-642.2444) TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERG11ROOUU�,,ND UTILITIES. <br /> PERMITTEE SHALL CALL(209) 937-B44-1724 HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> INSPECTION. <br /> Read General Provisions on reverse side of this pepit before signing - Note requirement of notifications and inspections. <br /> N rr <br /> tat•Pertninee 2nd FiN 3rd-Rnawv dlh•Ulliry/Slmtl <br />