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____65/08/2008 13: 59 12098691 9 CTY OF RVRBNK PWS PAGE 01/02 <br /> CTY OF RVP.BNK PUB <br /> PAGE 02/03 <br /> 04/04/2008 11:38 12098691 <br /> _Y <br /> O <br /> x ENCROACHMENT PERMIT <br /> FACT , <br /> PP <br /> OKI <br /> PERMITTEE INFORMATION <br /> 009 <br /> rj / Y (TQ BE COM/JPLET�ED BY PERM{TTEE, PLEASE <br /> 7 rn 7 O �m A$BESSUc rrnCF_L n�nw�.? <br /> 4O T tN OP W ORK OR PROJ CT T �,�• <br /> GO/r so I7 TKO' L-rWNTACT NA E <br /> PERMrTTEE <br /> L� rrSa 't �l�Cr ere CA.9hr 5�Q -4 N� 1 A%NUMBER <br /> ADDRESS CnY15--- -- <br /> PROJECT COST ESTIMATE: <br /> CONTRACTOR kNFORMA lin ` 4S5e)l <br /> ro I t /' GONTAC7AME ! / y <br /> �pNt'Rp, F!PE ORI NG W C `„ ] <br /> ~• PIL <br /> ADOR62yS. CtTY1STATk?2•'P PHONE NUM6Efe i`rwc nUrno`�15-" <br /> C�7�/VrJ r/.x 7 S 5USINFS—$UCEN$eNO. <br /> CONTRACTOR'S LICENSE NO. CLASS <br /> I have read, understand, and agree to Comply With the permit conditions which are a Part of this Permit. <br /> I further agree to comply with the current City of Rverbank Standard Specifications and Details, City <br /> Ordinances,and conditional requirements. l 200 <br /> DATE <br /> PERMITY 'S SIGNATURE <br /> f7ma'�rI -- <br /> DESCRIPTION OF CONSTRUCTII/ON (ATTACH PLANS): Fs p fes/ <br /> r r 6t lore ei 1 dreel4 V4 24 f f•U`AJ We Lct / (2Y I-HfGrV' Ief <br /> vA0 es 6� of? III &J 4 <br /> 1/ L. /� ifh �c f �rncr.t - SKr <br /> W It A. h;i CL /�rr� WZA CC ac ro crt9� M .r-+ <br /> c,A d cf4Curr.,,er4e rAre r a . �t�1 7s(9d <br /> ANTICIPATED START [)ATE: _ fuY1e ANTICIPATED FINISH DATE: <br /> sr /� o s� <br /> DEPARTMENT 19TMENT DATE <br /> APPRC� ;ED BY THP PUBLIC W Rl S ucrnr���v f <br /> City of Riverbank, Public Works Department##for inspections. (209) 869-71 28 <br /> INSURANCE <br /> (TO BE COMPLETED BY CrM <br /> ' PERMtTTEP'&INSURANCE CARRIER <br /> POLICY NUMBER EXPIRAITON DATE <br /> PERMIT FEE <br /> CASH DEPOSIT pERFORMANCE GOND LETTER.OF CREDIT 0 T HER <br /> TOTAL AMOUNT PAID RECEIPT NUMBER <br /> Page I of 2 <br />