0817may'`" `''�'��"�:•�,,���s���. �'a'�-��-� � :..tom ;;,�'`�t�`:_ '� �'�r:'��;��.i:�=�� "' _.;.tiba►w
''ai, '� d t . ,•X7 .l r • � Y f'" �YFl ! ' � . 4'r �1 1 �. (•
•.:�r�-,� ��..� .tx fair r _.
NOTE: �.
With proper validation
• this form constitutes an
CITY F TAR. V_
encroachment permit O f LA YQU I N '
APPLICATION .FORS PERMIT -,.• � - �
• IM
' _•t' . w.'L .
PUBLIC WORKS CONSTRUCTION -(ENCROACHMENT)."'.,
' ONE TRIP. -=OVERSIZE }LOAD PERMIT'L•.t•` t oFT[�
For the construc'tion'.of public or private curbs, driveways, pavements,, sidewalks;' parking .lots, sev'vers, water, mains
-and other. Iike'public vvorks improvements in'connection with MINOR, IMPROVEMENTS and APPROVED,SUBDIVISIONS
Subdivision Improvement Permit — Class III•
DATE: 9-6-:.90
{ ti Minor'linproveCl
ment Per ass IV
• 7 I.
LOCATION OF CONSTRUCTION
(Street address or Description of Location):
O MOVE' EQUIPMENT ' Y
PURPOSE OF CONSTRUCTION. - Sketch (attach construction plans�if appropriate) -
DESCRIPTION OF•CONSTRUCTION 633 CAT S(,FtHY1�, r T : HAUL ROUTE: r
iwashington-S 52 e/b to
f city 1�imits ,.
DIMENSION OF'INSTALLATION OR REMOVAL IA• I A 11 '11 11 7't-
r,. i .a��_ �: �. a-- 7 .t - - . f ' t' _ ♦' t w {
Y SIZE OF EXCAVATION, IF NEEDED
r
3
°'APPROXIMATE TIME WHEN WORK WILL BEGIN :, '`��
APPROXIMATE TIME'OF'COMPLETION
'ESTIMATED CON$TRUCTION.COST $ �4 HAUL DATE: 9— 6-90
(Including removal'Of all -obstruction, materials, and debris, backfilling, com
4 -
paction and placing permanentsres u`rfacing and/or replacing improvements) ` -
i+r .4.
,
In consideration'�of the •granting of -&s' permit; the applicant'
agrees to: ? ' ,.,. + R
r Indemisify, defend and save 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 oto persons or property
• happening orroccurring,as a proximatearesult`of any�w tirk undertaken under.the permit granted pursuant to'this.application. 1 '
+ Notify the,Administrative Authority'atleast twenty-four(24) hours in',advance of..the time when vvork will'be started..`, f
Comply with all 'app' licable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of .
La',Quinta and to pay'for.any additional replacement necessary as the result of this work."' 7 -
Ov
Signature of Applicant or Agent t x -•
�;CATTRAC_CONST. INC^ ,,. 1030 SLOVER FONTANA CA' 714-355-1146
Name of Applicant (please punt) ' • -Business Address' Telephone No.-
'MASSEY;+ ° ON 'FILE J ;
Name of Contractor and Job Foreman,,'- Business Address ; F,Telephone No.
ON FILE
ON:•FILE ,
t
Contractor''s License No. •r • City Business License. No.
ON FILE ` ONF ILE . t y
r Applicant's Insurance Company :• ry - Policy, Number
- a
FEES: Subdivision Improvement Permit =,Class III
Public improvements: 3% of estimated coristruction costs ' ' 0 Si 05�—Oh ;90
10 • ASH.TUAL i i0,00
Private improvements:•3% of estimated construction costs
Minor:lmprovement Permit —Class IV: See attached schedule
Inspection Fee s $ PERMIT VALIDATION ,
Permit Fee'
1.0:00
Penalty
Cash Deposit -Surety Bond '
if required
TOTAL
Receipt No.
$ 10.00 ,
Received by Date
PERMIT NO. 0817
DATE APPROVED 9-6-90 {
EXPIRATION DATE 9-7-90
DATE''1S_SUED 9-6-20.,
By
AdFn„inistrative Authority
Recorded by _ 11 TELEPHONE: (619) 564-2246
i0
c�
.- - — — — - — — — — w — — — — — --
NOTE: r
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE TRIP OVERSIZE LOAD PE'0111T
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE: 9-6-90
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class I II
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 40)VE 9QUIPi1LNT Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 633 Ct�7C S'Ckrld
u
DIMENSION OF INSTALLATION OR REMOVAL? 41 A Wh
lonr,,
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
HAUL ROUTE:
washington b 52 o/b to
City limits
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
H)t UL DATE: 9- 6-90
Indemnify, -defend and save 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 occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules.and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
�'•�>, r � ,
Signature of Applicant or Agent
CAT�RAC CONST. INC 1:030 SLOVL11 FONTRNA CA 714-355-1146
Name of Applicant (please print) Business Address Telephone No.
MASSEY ON !'IL�:
Name of Contractor and Job Foreman Business Address Telephone No.
ON FILE
ON. FILL
Contractor's License No. City Business License No.
ON FILA; ONFILE
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
10.00
$ 10.00
Receipt No.
Received by Date
�OU0S1.'VA9 I � UtAL �f,-90 10.00 �q
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
0817
9-6-90
EXPIRATION DATE 9-7-90
DATE ISSUED " 9—G-9'10- 1
r
By—
"'Ad ministrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
..
A
`
b �5
r
w l•�R�x �.`� tek ?r.N•. J✓`T�„
,..,�..��.e.,,p,,� - •a
-
r,
1+�'�-x`i°!./��. t!?Snf .t � •;r.
i ' � -
3 CATTRACONSTRUCTION,.INC.
10 6 7
r 15030 SLOVER
FONTANA. CA 92335
`
PH 714=355-1146
' 90-40MI222 -
i.�1
I .•
PAY
19 l
t"
,
OF
±.ORDER
N v/
_
YJ.�i►`-
ai-' , : / U-0 '
DOLLAR" S
1. - •
�' < CYQM44$INn A-- fNIM♦CA 42576
41,
-
,FOR
00}L067u!.+�: 12 2 2408901:
00 L�!0086 LIii'
4
Yy. .. ...: .f :.... ..:.:::v{•4::.4nv}::};........... ; .: v..v,.; .,}{.r ....:.}•ry;•: v::4$}:}:4'•:<:.j:•.}::}i'•i4'•{;:{::}•:}v
.. _ :•::,,,},+•Y •.::4}4 rf {;Sia.•r S•,x rs,}:; 'iS:}n• Kd.+ r+r.4 •w: r.v}}::::
S^• v. r, `••:ttr:' +:: �-., ,..k:,'•5.:::.>?•'{:r
.... +•4�
•M'•• k
};'-:'::. :'tik. .::: a{::..}}..:
k;., ..• 5 S'}} 5F}#4 ` "ofi�k':ik•:GYnS:•cw.Sroaik:ui::ie:$?sci:Y'iC!''
.; „Str.SiC•,tS. . Fr5 .k. +• ,r�...". {
::'E'�;. ISSUE
:amr .v; .� 7 f J:?rf'>' DATE,, ,
,
^4r: .; I.:'• yr , �
,yy { �,:ik " ;S{(/' S i r'�5,:,-xpt'•:'t•:2%,�S:;i'
i : Y%"y"+.•
�?" {? •` • y
PRODUCER
THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONI.YAND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOESNOTAMEND,
Austin; Cooper,&.'Price
EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW
2131.' Elks- .Drive-, 2 O O
°
,' r,
COMPANIES AFFORDING COVERAGE
• San Bernardino CA-924044
:COMPANY ,
A
" ,. •�.;" "
LETTER GOLDEN' EAGLE' INS . -CO.
COMPANY ., t
LETTER e KANSAS .CITY FIRE, AND MARINE
INSURED ' ' '
� _ t
COMPANY c
. CATTRAC CONSTRUCTION, INC
.STEPHANIE DINEEN
LETTER ,
a
P O. BOX ' 2 0 6 9
COMPANY v
_ . • _
UPLAND , CA 91785
D,
LETTER }
COMPANY �1 f
E
r
LETTER.
•.
.... ...... ...... ...:.. n:.... •.. ::+: :.. ..... . . ..tiA:i' vri.'{;: v: ,x, .:{+.:i+,.v.vn;{;i,{ti{'4Y:tiM;{.::niY}}'{: i •%:•'J..:.;,'ti, ti{i+-ri{ti,4.ri, v.,i': :';4:ti•:vi,;4:: ,'u,ti' ,
v ..: v,............ n..,,..v ....,.vv vr. •.v{• :•.v. .. ... ... } .. ;i{r•:vi0., .. {i..4:i;v., >... .: ` }'S !:;{+{+'.:{.}:::?r{:.
��1i .Y ....ivvv: x: v:: >.••,.....vvvv.. +i•.... i.,.v r..,v,..v: >,v.::w::.v::n,viw:::., v. •. x{v:•r.v •.ivv,. .. Irv.. v. i..:k v •4$•.�••n: :� �:<}.2ii?Yn't'�i is �`C%:Criii}:�q pix, •hvv •• v
•rv}:rnr}-,:•.w::::.v.,vrvv,v: rxvv::.•: v.vwni,i•: rr.:vx}rnvx %i> '�v ,•k iivv.•Y' >.�}%G {{v. w ':i' i�ak,..v :•rrr fi+Cit{•'.vv vnvm.:.{.:: rn•x: n:fvx ,�iiv +
��{� >vr:•••v::?..4rrr:r•::4 .}+. :.•h +vC�•kiv'• .Y r%:?. i
:. ,},y. :..,v. .., ..... •: n., ..; .... . ,}....
v{v:::•h�v..,.:v:{:.+:::.it/.{M7.?iti::{:%:L:t`vi:}}{{i{•. •.tiit,{•Hifi:�i>.•hKS{{-:S�?;vvi:iv{i+::}.•R4.:{::<Sk}it•.2>rv.Ci<i4ri<:{:?ti%:i�1:JLi>.<Li%\�{>.v.,?+%iSR��ir:{.�i4:Yi$:t�.t�'{'i���O�G�2<tL{i�YiC?�:{i'ii'CZL�iXYiL:Ztt>.i��A6:•:?4:<7:iG+/.�%iSL:�i�'i4V.i?CYi(G#X{,`?:�W.
THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REOUIREMENT; TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS.' ,
CO•
+
�TYPE OFINSURANCE
' ..: ' : ^ '
POUCYNUMBER
POLICY EFFECTIVE
' '
POLICY EXPIRATIOIN'
- ALL LIMITS IN THOUSANDS
TR
r "
DATE (MM/DD
DATE (MM/DDjYY
GENERALLIABILTTY
'BINDER4944. , .._----'
08/07/90`
08,/07./91M
GENERAL AGGREGATE S 2j,000
•COMMERCIAL GENERAL LIABILI`
_
•yr;'"
=1'
PRODUCTS -COMP/OPSAGGR' S 2,00.0-
PERSONA LSAOVERTISINGINJUR S 1,000
y
kA; MADEUJ
t'• r
v�A ,� „�
X OWNER'S & CONTRACTOR'S PROT
'! "`"rr
t 1'+t) - .•,_
..,-� z�
l ;` t�
� ,
SRL. ��yP_.
EACH 'OCCURRENCE ;. '� S 1,000
FIRE DAMAGE(Anyone fire) , a 5 0
V
�•
S'C..
n�Y
R, ,
}�.f.. ,
MEDICAL EXPENSE (Any one pereon S - 55
3 } ; •'�►�
'-= ^
-.
• — _-••t...
AIJTOMOBILELu81LIiY, r:
t •- • ' %
BINDER4944
08/07/90
O$/O7/i91'n'SINGLE'
'{4:4Y:rti4:j0�g0:gj{S'qt
COMBINED �>SaSrr vim? a; a n.,.•
pp 4�c
ANY AUTO i+.
! ►"`�� 1..
.s r
LIMIT 1 000 :}��%.::<}::..
X', ALL OWNED AUTOS'', ' `
$ , ..
'! /
-•.,:. ' i
:.
BODILY 5?;:r %v }` uEo?<
#,;:.`
'
t
INJURY S t
Per
SCH EDULED AUTOS • .
person)
MIRED AUTOS
BODILY ` };''':'s}#' i?4}:•}}::
INJURY $
AUTOS
l •
, !,.
,
y�, „�.. ,.u4
�..,_
)
.T¢22;j;k:S•"%'�xv:
NNON-OWNED
GARAGE LIABILITY •
s-
I
.t
-�' `•
t
PROPERTY isi;rizs.'•+::.zi`?;f
• ..
a^
DAMAGE S tt ir:.,,...:
"
- - .
q:?M`M+}Q\K•>4.?{+ �:�4�n:{Y.•M7ti4Jv�}:S: fi}i
}3<%<c<`?`:ti EACH AGGREGATE
G•y
A.
EXCEs8LlABILITY
BINDER4945 ,`
08/07/90
08/07/91
_ ..
_
.:.
X OTHER THAN UMBRELLA FORM,,
+•.:
• 4}:{{?{4:r..::.,t•{;{at•:{-%iS:;!::?Sc: {<{:iSS4:•:
STATUTORY . :.. V,+:::}:�1's%a:22?:%..'•:Sr::�r<?w�v?.>s;G:<`iir;;:�:
B
77W83599109OF
06-/29`/90.
0629 91
WORKER'S COMPENSATION
_
,
S O O(EACH ACCIDENT)
AND
-� T
°
' - '.
L 500(DISEASE-POLICY LIMIT),
EMPLOYERS' LIABILfTY-
n
S - 50O(DISEASE-EACH EMPLOYEE
mwCARGO-COVERAGE
BINDER4944'
08/07/90
08/07/9.1
-:$200,000 LIMIT .
'
"SPECIAL FORM '
50
OESCRIPRONOFOPERATIONS/LOCATIONS/VEHICLES/SPECIALITEMS ,• '.}• •,
<•: k•: v': i'F.i}...: ,•ff•. :: M:rhr}}h}}:4: •.-; Y.)':.? :.{+. "} v �:SY;• '.Y: " w/.r. �>:
..: •• ?: �:.p {,v, :::{•.{i ...:.✓.4.4$: nvrii:?v •f-'.:i-nvvri\4 4}... {S!:%:}.v.:v.. r..n.....Y{ .; .. b +.� 3ryr:4{j„^; v n}. • v 4{: 4:C�}i .;v.:2r'<iS., •'
i'}:{;;{r:yt �:E ;+i „��, `�: ,'( .. vy5 �`-. ''?; �•�{,{.'.
v��j}lR.'• �. �++i�+3?.:v :.v•t t•: .v ...,v..." Y �•. i^ �tG�}' �} • 'tiC�Li2S�2�kuit:2J��.`�`K{'. `"f
r�4";'RC:$J.t%.�
YYi t.•�.2ffY7.,f i`,aaQ2: -
..,{',�•.{'si.:.,w:4�,.•raii4:i4}.4:{.?„-.�<.�,:,i,2�,�ki{2,.w:'C�i •:o&�2i':a'{�: . ;,i�2•r. .w2tYtih
:4 SHOULD ANYOFTHE ASO EDESCRIBED POLICIES BECANCELLED, BEFORE THE '
a £ EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL�gV
CITY OF LA QUINTA , MAIL30,_DAYSWRITTEN NOTICE TOTHE CERTIFICATE HOLDER NAMED T_OTHE '
ATT: OVERS I Z E LOAD . PERMTS # . LEFT. r
r • ENGINEERING 'DEPTir
78105 CALLS ESTADO <<
AUTHORIZED REPRESENTATnE
LA- QUINTA, . CA ,92254
{:rym.}::::{�.:r{::�„ ::.,,.
., .•inY:r::::�r.}Y.r::�w::::r :.r...{;tw{.r,,:4.:;{;.:.:r.>.{h}..4}�:;:�.{�r:,::::r4:::N{i� .. .:::rr ts''..,
;x.: ....... ...: ......: ...4..., ...:.,..,..,,,r.kqa"?o:4..Y:Y.{.:.vr..,.,{.%.,:..,.;:.::{.}:....}:::}y}},.: •,{..-x-t{•}..+•: Y:::4}Y•?-:}5:;:;Y}:.....Y.Y{S., r.; %:x..5f+.:.:.,.:.......... ;r.Y'r`.t ;.•'.••q^}.......:.. .../..
y} +. v ..........,.; w:... ..r;%.,Y}:w;•.r. orf r.:n. r.{4•ri?'`,iY: }:?:>."' ..
.. n.4 ..v..,.........v. n. n.vv {:?^r. r.........::: :•: ^}......::::: Y: nv4::•rn.....n ....aL'ri n}hv:nr/.•Yf{:?;}:k;:?{J:.n ..�.{{; �rr.':.n..4}:v}:>5::4
";i4:;i{w,�.,,:....:
.. ... .. •::::::::::::....,...,.,,,,:..,,,,...,,.,,::i•::r::::.:,.,.,•:::•::4Y:•;;•.,•::::::::;•.}::,,::::.,.,:...,,,,.::r ir.•:::::;ua.a •Y•.Y..... }:::Y .Y• ;>..;;.}, 4;4:.,::;YY:-Y .-::�... ..1.•...
I
+:"toSi6»
C/�TTRnC 0
NOTE:
With proper volidetan
this form oonetitim on
encroachment permit
' 217 ; J, 5-90 4 5i3PM ; 5647- 17143553797;#
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private outts, driveways, pavements, sidewalks, parking lots, sewers, water rytsypt,
ind other like public works improvement: in connection with MINOR IMPROVEMENTS and APPROVED SUEI)I.VISt0 N8
a Subdivision Improvement Permit — Cdim III
DATE: ` Mlntar Improvement Permit Class 1V
�•.�
�►1 a �l D n�tan.t-�
• k
Skkeetch- lottech t�rtstructlon plane if appn"xia ,
DESCRIPTION OP CONSTRU t"1 A s W'^�� j-') r-) '
(.33 C A;+ s C,,t pest✓
LOCATION o>: coN6TRUCTtON
)Stress Wrap or Otesm�pdon o! 1.00ationl
PURPOSE OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL 1"Ar; s"•� • ,-Z`2"�•
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN •
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S
(Including removal of all obstruction, materials, and debris, backfilling, Doter
pat:tion and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
indamnlfV, defend and save the City, its auueorl:ed eoarrts, officers, raprataAtatwas and alnplovarl, harrw+ora from and :sgailese env setd all
panaltiat. liabilities or Iqq neultinQ from claims or court action and arising out at any acc+deet, Iota or damage to 4sswm or wa,sercy
happening or ocaur►inq as a proximate nwit of any work uneeRekan under the permit grentaq pursuant to this atstolteetion.
Notify the Administrative Autheriev at IaAat tveontyfour lZq) hours in ativareas of the time rrnan work will be rarest!.
Comply wilt! all applicable City Ordtnantsia, the corms and Conditions of the pennk and all appllmd9is raise and regulations of cns GJty of
V Guinea en19 to pay for env oddttioceal repeaaart+etet nsaeatry at the result Of this wocft.
Slgnatur of Applicant or Agent
Name of A ptieant please printf Business Address Telephone No.
Noma of Contractor and Jeb Foremen Business Address Telephone No.
Contractor's License No. City Business License No.
Applicant's Insurance Company Polley Number
FEES: Subdivision Improvement Permit —Clete 111
Public improvements: 396 of estimated construction coats
Private improvements: 396 of eatJtttated construction -costs
Minor Improvement Permit — Clan IV; See attached schedule
e -
tnsaaetlon Fee S ;I
Permit Fee LV •,��.�,�„_
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: 8—��,17 •!?� ��,—.,_�..,,,
flaceipt No.
Metiived by Date
Ftesordad by
N°
PERMIT VALIDATION
PERMIT fv0,
BATE APPROVED
EXPIRATION DATE
DATE ISSUED
TELEPHONE: 181E11304 -22+1e
Administrative Authority
. ■■_ 50 5017+ ti71405�37�"'��®
}.• SEP 06 190 06:54 CRT TP C CONSTRUCTION, INC.
m■� 02" a.A A" mom am= fto am& now owm mow 101D�b aWWWVM wm ft� rory
thle f4 FM ®rMIMAN oft CITY OF LA QUINTA
-am"a9 iftnt mmit
APPLICATION FOR PORMIT
x
PUBLIC WORKS CGIMMUC?■ 014 611NOKOACHMINTi
For the aaraotnra mon of public or orlvutt a3ltPtral, drlarowm, poa61v1ottti, sidemiks, parking late, swan, an, wgw f4t
ho
and other like public wa*o impmvenma in eoflfiwftn with MINOR IMPROVEMINTS array APPROVed $USbtVjjM,
U 9 0 subdty" lmpnmw rtt Ptrmh — Cim III W'.mm"�
Cp►T�:-- _ lmi.sommmmom,1 a , _ �� r - - - - - . Mbar Irnptamsm Mtrmil Chu Ill ff-mWammm mmumo
LOCATION OF CON0P4'PitlOM
(atmn of "me er ear ;"1104 rf Ltseti�i'
PURIDf#R$ OF COMTRUC'TION
DIMINISION OP INITALLATION On RIMOVAL
SIZE Qis OXCAIIATION, IF N1011016
APPROXIMATI TIME WHIN WOIRX WILL 110IN
APPROXIMAT5 TIME OF GMUMON
IBTIMATED CONI TAUOTION OW f
tlaaluoling ysmaaval of III almahm, frrmlaie, and dtl , ltae fllllnf, Car+tw
pardon and plealrat pernaerim r4> w tM4 a4W/tt rtpiealr+g ImpravewAml
In 40miderstion of the granting of this peer v, the applieem hereby semi t4-,
i,t'Ifr item m"naatlon piano If ISI.,
Indeimft■ a 4m AN wo *4 Oily, lot 11mmeriaed somm Diffam. mamamaet►u end molabaft ham im tram snd mm Arty No so
pondltiss. 11411h4o of too twAthv from ON" W Mrs mm" and Wilkie out of any 8Aridsm. I" or damp to beim & ,
hep0601M 0? 0"104 0 a praAshrfOtoo tats N d6 tear VM* a►dOa44eW uradler tike sareelr araOM summot is dig Arn Wstisn.
NOWY um Admhtissmi rA AmNtor W It WIN MEW~ 1341 house In jdvaM of the bean v*Sn I ork w(N be artradl.
CorndiV waaot all 119011" Oily 01da that limo 27A 000" 41 v*senelia trod ml am**,* mso end rwwerhm of Ir1s ow#I
IRS 4o
LA Cyhm anmy for OW ad""" 1"Aampam ftammmy 0 01 ?MIS of Ibis
2k'.25 -=
N- Qlgnetu of apliaaitt or �►ypaat
p /G
of Al
Addmm
�& 7/y-3ss` ✓�00'e
Tela nhnta0 No.
n1emv ®f Ceantreara3t gnat JOIE Foramen ®Ilsira®ee A�reu Talaphana No.
Contractor's Ltuns 410,
'dity husintas Licm No.
Applicant's Inaaarenae C0 1tI�ly
Policy Numiser
Fi�lEa: i4arb inlaern+�C Ie� 419