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<br />9P3~DGf. -30
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<br />OATE: B-"3- DO
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<br />CI'IY Oil ZEPIIVIUIJU,S - IJUJI.UlNG DEltAR1'MEN'I'
<br />JUGII'I'-Olt.WAY USE ItERMI'I'
<br />
<br />PERMITN 9? (:, /
<br />
<br />No con.'l'lIdlon under around or .ho\'e arouncl or .ny r.clll')' ....III,e .ccompll.hed on .ny Clly R...... .r w.y "".bou. "'rlllen .ppronl rrom .he
<br /><:lIy Dulldlnll Dt'p"rtmen'. Any .PpUe.llon rDr ."ProY.1 or con"l'lIdlon oper.llon. on .ny elly 0"'." RI..... .r W.y....,1 ftlmhh . delaW dra",". ...."...
<br />the complete acope or IIIe propoled "'.rk In 'rlpllc..e '0 the office or 'he Dulldlnll Officl,,1 ror "pproY.1 prior .. .... commencemm. .r any ",.rk. A co".r..... .
<br />permlll, '0 he kepI re.dl'y .nll.ble .. .he .lIe or '''e n.rk .. .11 "me..
<br />
<br />PARCEL I.D."
<br />
<br />el'l'v ROAn
<br />
<br />AVI P.TIDN avE.
<br />
<br />DATE
<br />
<br />LOCA'fJON (Le,.1 De.erlp.lon) I . '.
<br />FItoM. T t-\ E. kloeTH ~ I CE
<br />~~)~~ ~\f~I~N ~VE
<br />Fo~ ~~~a AV/AT/n A E.
<br />
<br />I
<br />D~ AV, ATtaN AVE. - '. CJiP~A1~ ~ ~H~
<br />A.... A P(JINT ~ 15# \iJEsr -n";; THF /:'. (II L_r
<br />
<br />Perml'.lon I. hereby ar.n'e" to
<br />ror 'he con"l'lIdlon .nd m.In'enllllCe or
<br />
<br />h,E-
<br />/%>fJPIEf)
<br />
<br />or
<br />T'ELI;PHtJf'o,J:E C~I3LE IN c.~/J&:>urr ~/)!>~ AVJltlTIOJV
<br />
<br />.ubJed '0 'he follo",lnll cond"'onll
<br />
<br />2. All "ork .,.~II be d.ne In kce"lnll ",III. '''e ,'.nd.rd. of 11.0 Clly S.reeb Depath\len' .nd under'he .upenll.....r'he Clly BuDdin. ome.... who
<br />"III be nollDed .. Ie... .ne d.y prior .. commencement Dr eon"l'lIdlon.
<br />
<br />I. Tho con..ll'lIdlon .nd m.In'enance or ouch uUllly ....11 no' III'errere "lIh 'he proper'y and rI..... .r a prior -pan'.
<br />
<br />3. All m.'erllll. .nd eq..lpmen' '''"11 be ...bJed '0 In..pedlon by 'he elly DulldlnlOIlk..L
<br />
<br />\ ... During con"n1dlon .1I.are., repl.'lon. .f 'he Depat.mm. of Tnn.por'."on .hall be .b.ened an. 'he CII,...... b. ...Ue..4 .r .u
<br />re.pondblllly from d.mllKe or .ny RaNte .rlllnl rrom .hl. pennll. 8..bJed '0 .... '"me 'enn. and condl'lona, .he penalt hohIer ..yfake.uch ..rety .cu..re.,
<br />Ineludlnll pl.elnllllnd dl.pl.y or e....1on .Ipu, .. I. m.y deem n~...1')' In condud of eon.."",,1on an. ."'Ienance w.rk hel'lWlder. It.. Ihe hlpoaelbWty or
<br />Ihe permlUee '0 pl.ee, m.ln.."" .n. ,u,enlle .11 'rallk conlrollln. dnke..
<br />
<br />S. All prlY.le .nd .11 CI.y properly ....,1 be re.'ored '0 II. orllln.1 condlUon .. r.r.. pl'lle'leaIln .... .'......r.... CIIy Bullcl.... omelaL
<br />
<br />.......
<br />
<br />6. All ullderaround cro..lnl......,I.Uon. .h.llbe 1.ld .. .uc.. dep'" .. mllY be .,'eeIOed by .... City BulIclIn. omc"L
<br />
<br />7. The .ke'ch co"erInK 'he de'.II. .r .hl. 11I...II.11on ....11 be m.de II pllrl or Ihl. pennll. Thl. penal' It .nn'e. ,,111I ....lUId.n.....ln. ..... ....
<br />.ppllc.nl h.. no"Ded 1111 .'her uUllly Ulen In 'he .re. covered by 'he perml' .nd '.ke. ftlll re.p.n.lblllly r.r IUIJ' d..... ....r...d by prior ....1a1Ia.1ou .. II
<br />re.ult orhl. operllllon. In order .h.. 'hey may..re pud 'helr In.ere....
<br />
<br />8. II I. eIIpre..'y .Upul.'ed .h.. .hl. permll I. . Ilcen.e ror permn.ln u.e ollly .lId .h.. .... plaeln, ., rllClllllet llpon public prop.rly ,unllllft' .. .....
<br />permll ....11 no' operale '0 cre.'e or '0 n.. any properly riAl" In ..Id h.lder.
<br />
<br />9. Whenenr '''e Clly dftldCl I. fUr"ler ell"o" .h. CI.y HI"'I. .r W.y, Iny or ",I..ld p.Ie., "'I...., ,1,.., cabla,.r .'her l.eW.Ie. an.
<br />."urlen.nce. .u.h.rlzed hereunder, ....U be Immedl.'ely removed rrom ..Id RI..... or WlY, or re.e' .r reloca.ed Ihe........ required by .... CI.; O.U.....
<br />Omel.1 .. lhe upense .f 'he holder .r .hlt perml'.
<br />
<br />. 10. The h.lder ....,I.AYe anll keep .he Clly h.rmle.s rrom .ny .nd .11 d.11I.le., cl.lm., .r InJllrtee ..... ..1--r by ........ .r... COIII.ruet....
<br />m.ln'ell.nce, and oper.'lon .r ..Id r.dllly.
<br />
<br />II. The holder .h.1I eomplel. .he re'lue.'ed "ork wllhln d.y. or ',11. perml' .haD beeoan. nua IUI4II y.l.. In 'he"ent die "'.rIe ........ed
<br />I. no' comple'ed upon IIIe ul"rallen d.'e .r .hl. perm II, 'he elly .h.1I h""e nle rlRh' '0 eomplete .ueh "orle .... .. ..... ... holder .r .he perm I. r.r all co...
<br />Incurred In comple'InK ..Id work.
<br />
<br />12. 1'he holder .hlll".., a e..h vr .ure.y bond "I... 'he Clly MIIIIIKer In 'he .Uln or S d.I"n I. pann'ee perr.1'IIIIUIce .r.... .......Iona
<br />herein, .nd '0 gUllr.n'ee mllln'~nlUlCe or 'he rl....-uf."'.y described herein fvr . period of one (I) ye.r 10II0"1n1 ~p...1un or Ihe ....ueated ............. In ...
<br />nen. · .ure.y bond I. poaled, 'he .urely bond .h.1I be made p.y.b1e '0 lhe elly .nd .hall vbllp'e 'he .1I....y .. hold lie CI.y banalet. In ... neat die hol.er .r
<br />.hl. I,ermll .hould r.1I '0 mcd .ny vr II. .bl'I.'Ion. hereunder. Tile bond ....,1111.0 IndemnlrYlhe CI'yl.r all court ........ re......... .U...,'. rtel'" die
<br />nen' leK.1 .dlon I. required .. coiled en .lIld bond. It I
<br />
<br />13. The permlUee ....11 have. 204 hour emergency CIIII'"d n.me and nunlber 1I..ed belo",.
<br />
<br />(PcrmIUrr)
<br />
<br />SUBMI'I"J'ED BVI
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<br />81........ Ie "'1I1e
<br />
<br />Addre..
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<br />33?tJ /
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<br />Phone
<br />
<br />O..'lcIlng ome",
<br />D,'er
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<br />1(- 'i'-o,)
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<br />Ulllllle. Supenl."r
<br />D.'el
<br />
<br />Public Work.
<br />D.'el
<br />
<br />~~? S(f~"
<br />
<br />elly M.....Ker
<br />D.'el
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