0267 (2)Of
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es'an�',- �404
stitut
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CITY-OHL
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encroach�miinfperm iv,�':* Z,
,�Witli prop., r.yaliOation,, x
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APPLICATI FOR`' PERMIT
UC"'WlblkKS�6014STRILICTIOW (ENCROACHMENT.) ot3lA,:'
PUBLIC
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For the 'construction"' of p6blic, or private 'curbs ,.. "driveways, pavementssideWalks';Oarking;' 10ts,.,sewers; water mains .-,
MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
in n in connection _,ano other Ii , ke.pLiblic works. improvema ts'*
J
0II y
87 u� .y :Subdivision`'
Improvement Permit it Class I I I
."
E:' July: "2 TMinorImprovenent
Permit Class IV,
mot
,
LOCATION OF CONSTRUCTION
4A
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(Street address or Dekription,�?,f.L'Pcatip'g)-,.-
•- '%? -t ,
�X-
FE QF:CONSTRUCT-ION',
'k PURPOSE t construction- plans rf
appropriate)
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FSCRIPTION,OF CONSTRUCTION.
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'DIMENSI!QN,OF LAT1,0N.-Pfitlig YAL'.'-"-'
40
77, -7-
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SIZE OF EXCAVATION, IF NEED'EW—
Af
WHEN WORK WIWFBQ9,!N',—
;4: ,kAPPROXIMATE TIME
USA Inquiry No..'
APPROXIMATE TIME OF COMP "Tjj
777,
'ESTIMATED CONSTRUCTION COST
Date,lseuiid
ba.ckf illing,-co'
M.
,t:, IncIuc!jng.rern6VaIjSf
,4pil"Postructio'n" ri ,,;and debris,
poption.jmd -"placing iermanent Ires /0' cin"
r:re improvements)
% Ra g;
n. her
-consideration, of tthe.grepting,of this p0mit,tthe, applicant by agrees, to.-':-.4tl t,
-6 ls?.V
agents� of ficersi-orepresentatives,an a lo eis * r
' ;, .,. , i4 - I j
ni :diefI..Is jr-n..., n and 811L
ourt.action and arising,out'of an 'acci ent;t � I oss or damage to pe I rsons' or. property
wqr�'uqqeqakqn undei"the per i ni -ursuant:to this application.
ild�'iricil6f i t 'I' 9"whi 0 ill-be",starte
!jvanm 6 it d
s,and,condiiioni ot the permit and all applicable rules and regulations of the City of
uin,ta!and to for, any additional necessaryreplkqrnent.as the r�suli•of ;his;yvq k'
pay
j,
!Signature. of Ap 4
Agent �plicant'6r Age f'�
;:568-2828
d'. un
National -Mortgage and',La'n "Ik-00`Cq try'Cj�xb Drive,- 'erf"T44
9 Lr.
"Name of Applicant print) 'Bus* ss ,`!�-,Telephone No."
plicant (please I I iness Address "6- N
4
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Name � of Contractor and. Job, Foreman BusineisAdd�es
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Coritra6tor,s . L ir cense'No
it sine`
Licensii -f J'�,
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cy,N4l;iber,�
-c A oli,
Applicant's' - nt?s'Insurance
7,
'FEES: %*• Subdivision Improvement Permit --Class 111
P 'I V
q
ublic improvements: 3% q estimated construction costs, v
.t Y
'Private impir.94emen1s. estimated consl
t,- L .. iructi'6n,costi
IV:' a al V.
Minor Improvement Permit schedule ..M lass ttac!�d pi
•, .•��� . ,..�� r• �:- �� '� •'�- uwf. i.�.�1 �±�,�-x"�t�,�k��"£�,�t��+,�la�:ta��rY��r��'���� r Yf
Fee 1 331-;32','-" IS
$
1�lnspectiorif .,PERMIT -VALIDATION
10.00,
Pqrmit'Fee'm', A
PERMIT NO..
nalty'l-f V.
-Surety Bond
Cash Deposit DATE APPROVED
if require
it t.EXPIRA N'DATE
(on Biles
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Indorrin d end end
t�, or
Pena es"'Iab
h P�Qn r �rrin
e n9,'o
Sketch
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urfac
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y
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halt
N't.ltv he".Ad
Comply
v with
I .applicable
h .1
La Ouinte.iind'tq Pay
TAL, 1,341032
)TO
DATE.IS§jL&ED,--
D,
Receipt No.
x: rBy
77777
'Administrali'lve Authority
Received by Date —
"A -k
gyp
7
.Recorded by.. ..i!'TELEPHQNE.'(61'9) 564-2246
4