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With proper validation rthis
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1onaoedtmentparmil C)TY'OF LA OUINTA ar t• j �a+K,r.:
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; APPLICATION'' FOR PERMIT
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PUBLIC WOAKS CONSTAUCTION (kNCROACF!
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o ttubtle or wivate curbt.'d4"evavi. pavamente, sidireaiks. parking Ionwow.
and other like Wbiic rrerkr imprOW p. nq saigrs. melna
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'_DATE: fl�Z 1 - Subdivbion Improvamunt Patinit -Class IIC.
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`. LOCATION " Minor ImproeaitaIn Permit Clan IV - • ' r
OPCONVAUCTION c�nNER g(r •cAL_l£• 4 NL+(,At.E$'
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PURPOSE OF ~ RU'TION EPALSI MAb f tie iif ' +
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DeSyRIPTION OF CONST RUCT;ON V 'T 1 v' " •Y` _ ix
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APPROXIMATE
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MMATEO CONSTRUCTION COST B t • R,
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.Ilrlciudulg. removal of all otistructloo, trvterlals, and debris: beektillini], coin. r• ¢- - �.'��• i. �� t; r
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peclion and OIeCN,q aatnanaatt rvartlaoirg and/or replacing imtirororne>,pl k ' ' i � '.
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in comideration of tfy gtaeltl of this t alto f'
nq Oermi applicant hot@ apraef to:
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DniMtia. 401 tin or Ion rewlpee trap CIreM •
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eaootntM or oacurri u a ration erge•nin8 out of wilt weident, loss Irr 1
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ou'seant tii this epe "Irsn, ..1: ketiN iry ASmIn3nRtiw Autiioriq et irrt ii�vilry.tgyr (2N ewrsin ad,.nca.oft i'r,� t�
the tame vatol work w"i be uterlM,
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f:awWe niei an segittpn City Onairwriaw, iM tare ero.gonditloirr et thr ilennit ono es eooliaspra rules ina,npJnlpry of Mr Ctty ee
1111 to Qurno and m my to, in v eaiaitw-w.!orrlont Reavary at the rewt of Mu we. ` '
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-SigntlWre of Aeplltyn: or Agartt - ,:., .
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Name61^0oli mtpiewprint�ER - HA REI, sin miTLA. LoMA-C/q �{�°� 'j60•7000
C * ^ Bwineti Addiaaa
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Name of Contractor ond':►cb Finamar!
AddrtN 93 333 ti
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Contractor's License No. - - ,-• " •_ ,
ACC N S ! a City BWltttrH litttrt�ata No. '
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PEES: Subdivision Improverttevtt Plvrn$ -Caw
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Priyam improevftenle: S% of ettlnuted tapnal •. - - "• ,
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Im t plertett - Cie". IV See ettaclad rehetlule • `
2,77G a ;�
IftapeeWn Fee
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Penalty „ l PERMIT N0.'
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Re0lw�bY Admrnistgtive Autho►itY .- SI -' .•J
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