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<br />DATE:
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<br />I~I //Iit/ (1'1
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<br />cny OF ZEIJIIVIUlJU,S - IlUlLUlNG UEJJAltTMENT
<br />JUGU'l'-Olt-WA Y USE IJERMlT
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<br />PERMI'I'N
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<br />No con. hue lion under around or abon anluml or an,\' rao:lIl1,. .hall be accomplished on any Clly Rlpl. ot Way "'Chou' "riUen approvall'ro.. ,he
<br /><:Ily Dulldlna DepRrlmenl. Any applleallon ror al.proval or con~""Ucllon operallon~ on any Clly o"ned Rial'" ot W.,...." I\Imll" a deta"'d ...."......."In.
<br />Ihe com,llele .cope or Ihe propo.ed work 'n 'r'pllcale 10 Ihe office or Ihe Bulldlna Official ror approv.1 prior '0 'he commence men' ot..., "ork. A co"ot ,hie
<br />"ermlll. 10 be kepI nadlly .vllllab'e .. Ihe .lIe or Ihe work alllllllllle..
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<br />PARCEL 1.0. N un I (} (I I 1'1 U (1
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<br />CITYROAD (,~t"'el"l~ (,p<,
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<br />DATE lil / I b It)l'
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<br />Permlll'on I. hereby aranled 10 V <!" 101',1 .l ~ IJ
<br />tor 'h, con.lrucll.," and malnlenllnee or
<br />a Ne; G ...." t' -.:: 1 '
<br />.ubJee' '0 ~he tollo,,'nll condll'on"
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<br />2. All "ork .h~1I be done 'n kCClllna "Ill. 'he I'andard. IIr Ihe Clly S'ree.. Deparll'.en' and under .he ,upenlllon ot'he Clly BuDdin, Offlclla. ".
<br />1dll be nollned .. lea.' one day prior '0 commencement or con,'rucllon.
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<br />I. The con.lrucllon "nd malnlenance or .uch ullllly .hall nolllllerrere "lIh Ihe properly and rial'" ot. prlo.' occupan'.
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<br />3. AU nla'erilll. and equlpnlen' .h"U be .ubJect '0 Inlpecllon by .he Clly DuUdln" Officl_L
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<br />.......
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<br />4. During con.lrucllon aU .aCe.y rcaulallon. of Ihe Dep"rlmenl IIf'l'ran.porlallon .haU be ob.ened and .h, Clly ....U b, reUe..... .r aU
<br />re.pon.lblllly rrom damaae of any nature arl.InK rrom Ihl. pennl'. Subject '0 'he .lItne 'erm. and condlllon.. .he permlt holder ..ay take .uda ..fe'1..talure.,
<br />Includlna plllclnK and dl.play of caullon .Ignl, a. II may dum nrceaaary In cllnduct of con,'rucllon and ..alnlenance "ork herewader, 11 It .... mpOllllbW'1 of
<br />'he permlllre '0 pl"ce. maln'aln, and ,upenl.. alllraffic con'rolllnd device..
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<br />S. All prlv"le and all Clly prvperly allall be realored '0 III orl&lnal condlllollll' fllr a. pracllcalln 'he opinion ot'he CI.,. BuU.In, Official
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<br />6. All underaround crolllnlln.lallallon. .h,,1I be laid al ,uch drplh a_ m"y be alleelned by Ch, CI.,. DuUdln. OfflcllL
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<br />7. ' The .kclch co~'erlnK Ihe del"lI. or Ihl. '''_Iallllllon aha II be made a p"r' or .hl. permit. Thl. perm I. II ,ran'e. "lIh 'he ....................... ....
<br />applleanl h.a no'lOed all olher ullllly ule... In 'he are. covered by Ih, permll "nd 'ake. full re.pon.lblll'y tor l\II1.a"'lI,e InCurred b, prior ..........Ioru ...
<br />re.ul' orhl. operallon. In order Iha' 'hey mllY .are pllrd 'belr In'ere.I..
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<br />8. II II nprcllly .lIpulaled &hll' Ihl_ I'ermlll. a IIcenae for pernllaalve u.e 0111,. IIlId aha' 'b, "lIelnl offaeUIlIe. upon pubUo proper'1 pU"'lIlUll.o dala
<br />permll .hall no. operale 10 creale or 10 n.1 any propeaiy rlgh' In .ald hold,r.
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<br />9. Whcnever 'be elly decldel '0 furlher ClI,lolt 'b, City R'A1I" of W.y, IIny or Jill .ald pole.. "Ire.. pipe., ellb"" or .....r 'aeW'lea ...
<br />appuaien.nee. .ulhorized hereunder. .hllll be Immedla'ely renlo\'ed rrom .lIld RiAl.', of Way, or reae' or reloca'ed ....reon.. re.ulre. by.... Clli Bull.....
<br />Official a' lhe upense or Ihe holder of .hl. permit.
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<br />, 10. The holder .hall.a". and keep 'he Clly harmle81 rrom any IInd all d"ma,e.. claim., or InJurle. ..... ..a, occur It,.........r.... CGIU'11ICI1on1
<br />malnlenance, and ollerallon ohald raelllly,
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<br />II. Tbe holder .hall complele Ibe requealed "ork "lIhln d"y. IIr Ihl. permll.haU beco..o nuU and voltl. In 'h,....aat .... ".aiI rc.IIe,'e"
<br />I. no' compleled upon lilt tlIlllrallon dale or IhI. perm II, Ihe Clly .ball bllve Ule rlllb' '0 complele 'lIClt "ork an. '0 _'Ie .... holder of.he PC""" r.r all ce'lI
<br />Incurred In complellnK .ald nork.
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<br />12. The bolder .b_Ullo.' II ca.h or lurel)' bond nllb Ihe Clly Ma""ger In Ihe aUlD of S .0111... '0 IWlran'" perfotltlAQolOr.... obllp'loru
<br />IItreln, and '0 IUllr"nle'i malnlenance of 'be rlghl-of'''ay de.crlbed bereln for a period of one (I) year follo"lnl compl.Uon.f 'he ...queaW ..............18 1M
<br />evenla .Ui.'Y bnnd I. po,'ed, 'h, .urely bond .hall be made payable '0 Ihe Clly and .ball ohllgll'e Ihe .ure.y.o hol. .... CII, hannle..1n ...."...... hol.., of
<br />Ihl. Ilermll abouh' rail 10 medllny of Ita obllllaUon. hereunder. The bond Ih"lIl1lso ",denmlfy .he Clly tor aU COU" COl', All. rea.onable .,1011Ml1'. rtlt In ....
<br />even. Irl\al acllon II n.ulnd &0 collect on .ald bond. ., I
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<br />13. The I"rmlllee ahaU bave II 24 bour emerlcllcy con'"c' name IIl1d numller 1I.led belo".
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<br />APPROVED DY,
<br />CITY OF ZEPIIYRlIlLl,&
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<br />DulldlnlOfficial Il" c'",
<br />D.'e: .
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<br />SUDMI'I'I'ED BY,
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<br />(Permllltt) Y"e (! I {{I N (It" // ill', I) A
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<br />Slpaa'ure &: Tille lOt (. li ; l:: k.rlHt l){,:--;.., 'It I
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<br />Addrell 120 [:.." L I ""~. :Jf,
<br />J AK02 {{I "lid j:: L.3~ ~("
<br />Phone ~ ( ~ ' ,;l ~ _ ~ 11 :!t{) s
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<br />UlUllIea Supenllur ,'-.-r .)'<. l:.' t'"" ~
<br />Dalel iL;' /~ /" '-- '
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<br />Public Work. I. ,...-1.._.-.Lt
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