0284 (2). With poper v;lidation, r �, M ` F t
thls',form constitutes an - K:
'CITY • OF ,WNTA
,,encroachment permit' r LA {
,? PRfLICATION: FOR ITTHMIT ,' " 9•.f r
Pt, 'IC WORKS' CO.NSTRUCTION (ENCROACHMENT)
For the construction: of public•or private curbs, driveways, pavements, sidewalks,•parking iots, sewers, water mains
r . and other, like'public works improvements
-IntCco,(nn}ectio�n-with-MINyO,R IMPROV{,yE,MENTS and A?,P�R�}O�}V•,,ED SUBDIVISIONS
' .. : YM{.1./,♦�. M',a�T�'+u',�. Ji.ti.i}aT4{�Y.� R+J'*.,' YWIM"^,`.�^'M 'r .•�
..*+l.Y"'4Y•. •!!F''�+r'�,i-
> ubdiwsion Improvement Permit - Class III
DATE:- October 2� r,, �g8 Cr= '� gym` aSi• Minor'Improvement Permit Class IV '
LOCATION OF CONSTRUCTION —'; Washington Street` from 50th Avenue to•"Fred Waring Drive
(Street address�or.'Descriptiori-of "Locationl'bi4�.f�Y�,:i: t� � .'t+rtr �'x ::." ',�• �:' �"s;CLr�'��3�'1; 4"�l �;�� .� '�r•`.�.�':*".•t •td yid Z �:•wi.: � �;;;^, ;i•'�;.ri �-i:, ,'�
t"sStrlA"Z' - ►�;,h!• rat "'# w't>� '+� �}`1S" 'i',��i.'". iii t'i,+' 4•`i',
CO
ine construction'
PURPOSE OF CONSTRUCTION "s �. Sketch ,(attach con§tructlon plans if appropriate).
DESCRIPT.IONOFCONSTRUCTION 'r Sewer forcTe�m�ai�n See rOjflCt plans (34,sheets)
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DIMENSION`OF INSTA44ATQr�;QR REnnOynL 18" troch4 Notes The attached General and
xor^� o� s r'O`Sp®ci:alx Provisions are
• •tiaz.,r .,G.,it.-,: � 1Frr t,.L�C1 ,�% YwC�f{ t�Cl.. �a: G:i,aiYCfr, f Lid
a c r
included ' and inao& I a -.part
�SlZrgfOF EXCAVATIo N"'IF NEE Dl.sC� V. a1 YA�tti ?e 1� ,"�'. �at' �•Ot'�th18�'perm
Y (.ff4 {ifstJR}3� •r.� wrwe)aY:i.a
{ APPROXIMATE TIME WHEN WO K WIL Be
yEG N 9870 ,
�w� � . �a7 •: �.i.,! '•'i•Iw' +A ��''�i. � z �9 �`'�, - � i - � ' • � � t.. ,r.
Inquiry No i a . .. . -0,
APPROXNATE TIME' OFCOMPLETION Mareih 1, •'19A + _ ;
ESTIMATED CONSTRUCTION COST.$ ^' 'Date ' t'0� •=:z }rr ? .may .4
,(Including removal of ,all obstructioi,,materials, and debris,:backfilling, com
paction.and placing: permanent xresurfacing•and%or replacingeimprovements)'f t�'t i , d u . � i F + ' { 3 tStr'�; i 9 �•
In considef[8at'gn ofrt a grantingg f t is p emit„ the applican e.reby agrees to: ,p
• YC 0a1,t.M. :ski ii$ �f 1,v i:.F `L h�,4i.Il L'
Indemnify, defend'and}sage the.'City; its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or -court action and arising out of any'accident, .loss or damage to persons or property
happening -or .occyrring�as a proxyimate.result; of any work undertaken under -the per mit .granted pursuant to thi applica ion.l
t,. r { a i t v ,� t, A i Ilk.,
£a w �} W' •I (E 3 'a i4 rf+ta�' x v air '',gi.; 11 .-
Notify the Administrative AuthorityKeast, 0241 hours.in advance •of'the�Umefwfien.�wo Wil,! be<started,- r
`J.:J7' } • , , - e iid' xir.•. `i o � LA
Comply withr all appli able• City O. inances the terms and condi ions of-tPe,permit and all applic bl Mrules nd. `
rC m. ._a ?. S , a� ak.+e a �A :.s s�.� ula Owns o�fwihe �ity.ofti s
Quints and tog1�qApyay for.any add. itiyonap6treplla�caement necessar ;as the,result ofthis work
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. "'+++:ilii • ,} j��A, ^ - ♦ :J/�"N �y �•'�- f!'a♦ ,Vp•�Fy� r:7 t� ♦. f �v i
'�v%a@t. .•'�• *r )' .[.. w I..r..s '�'�'•: Y' 4 M iti� 7 (AMk „ Ir,� S�'. lr!YS •l.+h ,.{ •! f -.
y . 4 r
q-77
'>gna o e of ►pp lcanjel; 4gent
Jones 'Bios. Constr,�iQn P. B04 a. �Q fllieI'1 CA 92236'
Name of Apalicant (please print) � ,rKA' �' F * "� 'r
Cs >.' a Business,Adcjress: �3 :C'Ki 1�� w .;TeleRhorieAo:
., .. , yam,•}°kil+�` � ''`•' - ,� i. • .' � . - r: '{••'
Don
Ramp
'3�pe
Name of C n r88ctor and,Job.Foreman ; r, Buslnej$ gess Tele ho e.No
:,25. ?.a x:ti.e rlyt t m Y•r,' b.+ .�rC tirCi Jer Np iv
17209ry `01,
G`Fi_;r otj,on 7: e6—''o'�Cn.�s";. t I f4«.k i. � � 0164 :T•, :S � .zt-'n t �'
Contractoe's'License.No• C#. 'i
t:i 32i to �' s a
€ t• . a`�i 1a r �. . CitWI!Iusiness License�lo, i �;
at ft fC: C ifs'�,t �r"' ` '.�7�'f°i`•1-.�' +" GC
$nt
• r', ar w>� •:aures: 'i, i>,s, ; Ya•"sKx-�.ta.a.:.'oi r' ;.,X. x:•' ..
Applicants Insurance Coni
i.�. v. %. .• tial:'-aal,7� Sed .
FEESa Subdivision Improvement Permit —Class III ,
Public improvements: 3% of estimated construction costs <�
Private improvert�ents: s of estimated con§t�rjicti�n co;tsLA
'< Minor Improvement Permit = Class IV: See attached schedule
0
-In• i '
spect on Fee $ } PERMIT VALIDATION
Permit Fee= PERMIT NO. -
Penalty ..
' Penalty ,
p
• Cash Deposit -Surety Bond � DATE APPROVED /� 7
if required EXPIRATION DATE,—
TOTAL: �3_� -7
EXPIRATION
TOTAL:
• ;DATE ISSUED .
Receipt No.
By `
Received by : Date %�; i Administrativ Authority
Recorded by ' " TELEPHONE: (61.9) 564-2246 '