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1-~5-1 995 8_ 1 6P~ 1 FROP1 CEPJTURYWEST 1 St~':5t331657
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<br />t;1tV at ~al~rs~, ~~ STf~~~fi11ANE/AL~EvISEOEWA~K
<br />Pt~aG~work~ oepartment r CLQSURE P~RMIT
<br />?ransportatipr~/C~veloprrrent Manag~nt~nt Divisicx- ~~ ~*~,Z~ P!D Na. P,5$32_243
<br />555 Lit~rty Street SE. Raam 325
<br />Sal~m, Oregon 9730 ~ -3503 ~~ Perm~t ~ee $28.50
<br />Tefephone: {503) 588-6211 toa+~svok..nonoaneert Prvicessing Fee ~/0,40 -~~
<br />TTY~ (5~3) 588-8292 Totat P~ymenx ~~,.~p $~'
<br />48 HOURS NO~'IGE!?EQUfREL)---WEEKENAS F.X~LUb~D Perrnit Na. -~ ~
<br />APf~LICA7lGN1 FDR: ~] Street Gtosure ~ Lan~ Cioswe Cl An~y Cbsure ~ sidcwatk
<br />Sfree~i: ~~ ~~. r~U 1~1h ~L ~v3~1~`~~ / ~ ~r~J1/t~ ~. F % I~~ ~ f`~ ~~~~.rt J }`~ ~ ~-~ ~
<br />~ocation: ~,Z~ ~ 1 /-. ~ _ `~T ~~ ~ ~
<br />~ -
<br />aP~ucraNT:
<br />Address:
<br />Oay Pharte:
<br />~vening Rhane:
<br />AppliCBrtt i~ Cor~tractpr'? ~( Y~S ~ 1~1a
<br />CCfr1rRACTOR: '~7A r.~e~ ~ ~~a,~ re r..~~~'f Day phene .fS~~- S/Sr -aS5~3
<br />. .~~ ....__
<br />Adtfreas• _"~ `~,3'-Y~.--_,t~_' h~/r?~~^r !~~ ,~~~i::~ r,~''~`~. ~?~d~ Evetting phenc:,3~C~/ 5~~~6~77'
<br />CO~tfd4lO~'8 COnt~i Pc~54r; ~/~.~ ~rn~ / Day phonG: ,~3`~ ~~T~ Evernn~ Rhone: Y -~,~~7
<br />[1 Street Opening peeen~t ~ia: ^ Csty lyrojc~et Na.~ ~ Pr;vote Contract _. _._ .
<br />Reqvest ~ate and time of ciesure:
<br />Oescription ofwartc:o ~e aone~ _ ~.? ~,~...^5 ~; ~~~ r-~~ ~ L~~`~ --.E~?~-~ P.1~~t~5~'~ ~A~tfiL~
<br />1 Prrmiitee shatt tollaw the sign~ng r,equirements of the City of Sa;errt's "Tralf'ia CoMrn1 Martuaf fer Mainier~nce artd Construc~icn' ar~d
<br />any ott~~r ir~i~in cantra! ~equirements a~ needRd ar ~pedfi~d.
<br />2_ Ati wnrk snat~ be Qau ~r, ~ccardanc.e v~nlh a11 gppticab~e provisions of fadaral. stato ~nd local la+a, ordinance and administratrra -ule.
<br />3. Alt vwrk iti pubk¢ right-afwrey end all w~rk whicn is ccr+necled, clirect}y o~ ins~irec!!y, ta Ctry of Sa-ern water, s~nitary sewer, nr starrn
<br />sewsr Iines shalt be cortstwctetl in scoordartce with appticabl~ C~ty cf Salerrl8tarklard Consiructtan Specifrca~on~.
<br />4 Fer $~Qn~¢ c~axures tastir~g over anQ ~~y, C~~~~r sh~il r~atify the Emergency Comrnunicatians Cenitr a! 588-8923 eaCh day
<br />pnor ta atr~c! o~osure.
<br />5. ~ttte~ shaii ~ndemnify, detend and Save h~lesa the Gity of Salrrn, ifs afE',cets, empieyees, and ageriis karsr ar~y and aEl claim5
<br />arising oux Qf or In aqnrtection with any wrsrlt done under ttsis pern-R.
<br />8. This perrnit may bo roWUkod at a~y ti~ne by tt~e: Diredor qf Puh,~tts WpNcs or hi& d~ssignee.
<br />~ signa~~re af apr~icant: ~.~i, ~ ..rf.r. ~Y ~ l~ate: 1'"`~~/ ~~`~~
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<br />Date~ af Clasurt' Frertl~ .~~' /~-~. To: ~/~.~
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<br />Timv of Gfnsura; ~rom: C~` .~, r•-~ t r^~ r c`..~i ,..,~~, , 7'0_
<br />The (Streei) (~aneJ {Alleyj (~id w$ a C~osure indicatn! above is appro~ad subject to Yt~ fa~~~wing adcibans~l car~d'R~ons:
<br />~rat ~n+~ t r`~!1 Fw~-~r~n ~ `~fi.~~-J~+t~ ~,....~ i _n~ „~ ~t ~,',~01.~_.~ ~ ~'„r
<br />'~"Cri~~ . L` ~~ r~ .., "~`f~ r ~ _ i J n r Fy ~ tCt ~..'~-~,- t~ ~ ~~. ittt~ ~ , ., ~n -~ r-P ! .
<br />~e~it t~~r~d a,,:
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<br />Ci,er,Jc S Ghersc#~ Cash t A~t~d S~ PO~R R~e'd by; -----1 ~ 9y~ -
<br />YVh~~-TrpttlC, YCtlorr.~-App~+cant, P,nk-lnspesior:
<br />A~3d~tional cep+es. Parking ~n/e~ement, PW DisO~teh AW ~1CO~.FOR 46ft3196
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