Laserfiche WebLink
07/25/97 13:18 GR/GSI-SRCTO D02 <br /> 6G35 <br /> CITY OF BTPUBLIC ;i <br /> DEPARTMENT OF PUBLIC WORKS <br /> A& /� APPLICATION FOR ENCROACHMENT ON PUBLIC RIGHT-OF-WAY <br /> A Olica,n9Nama Gtvs�,Barrw/t1 Data <br /> IOwneNCpptr�ctryl <br /> Address 3�(d1 ( L' JfQ R7�!/ I_ PhonoL.z��' �-/.. <br /> CaR9�ni APPROVED: PUBLIC WORKS DIRECTOR <br /> Location of Prpppsed Work,pro _ <br /> _Y37_� m,,urt A✓L � .S77A�ir✓ ---------- 90li <br /> Dwnor I contr"ior Address . _ ... By DateE9tlmetetlstartingDale of CompletionDefa Eepiration Dale <br /> I (or We) hereby apply for an encroachment permit to carry out the following work : Zzlod ,div0 Gro. Awad <br /> __ dNL 6m..gHMIrG &W&W fI AAKIC- 72 A Aeol <br /> ._ SiLC4MLar �LAsalEO Gid G�,fNAiG✓/A sYP �-- - — <br /> The nbOre named aVPlicae,h,ny meoae.nerw,:asb�,a PERMIT FEE <br /> 5 <br /> Additional Footage Fee..... <br /> Sewor UP Deposit 1 <br /> TOTAL DEPOSIT s.._ .__S ....__. <br /> �x71rN Building Permit No. <br /> Improvement Plan No. _. <br /> Supplemental Conditions: <br /> Show akelcn aw.e a rorer m n,,. ,;npmnaM <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 <br /> the City harmless against any and all losses,costs,or damages resulting from in)ury 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 <br /> City Risk Manager prior to beginning construction. fi(�r/,i <br /> PERMITTEE SHALL CONTACT UNDERGROUND SERVICE ALERT(1.800 .2444) TWO WORKING DAYS BEFORE BEGINNING <br /> WORK FOR LOCATION OF UNDERGROUND UTILITIES. <br /> PERMITTEE SHALL CALL(208)937-841124 HOURS PRIOR TO START OF WORK FOR A CONTROL NUMBER AND TO SCHEDULE <br /> INSPECTION. <br /> Read General Provisions on reverse side of this permit before signing — Note requirement of notifications and Inspections. <br /> Spn�d �,�G. Z�a,�. Phene�yie)aa�-i3oQ <br /> Tat—verminee rnd—ane 7//d—F�nanoe <th—Vnmrl sv�„ <br />