Gibbs Station 1-CN 950612 WHE.~Ja~, TITE f;WNERS UNDERSTAlgD AI~D ACKNOWLEDGE ~T IN ~E
I~PAIRS OR I)~RO~N'I~S ~ ~QUI~D TO BE ~DE TO T~ CI~ OF
COPP~LL'S D~I~G~ ~EM]~ ~ICH WO~D ~0UI~ ~MOV~ OF '~HE
FENC~ IN O~ER 'J~f) EFFECT S~IC~ I~ROV~NTS; AND
WI{ERf~AS, TI'liE O~NER$ R~':COGNIZE A}ID ACKNOW~,EDGE THAT SUCH FENCE
WAS INSTALLED D~SPITE KNOWL=DGE OF ~'HE, CITT'S DRAIn{AGE F~ASEMENq~;
OWl{ERS f~EREB¥ AGI{EE TO REMOVE, SUCH FENCE AT ~Hf:IR OWN~COST AND
UPON R]~Q~ST BY T~ CI~
THE FENCE UPON REQ~ST BY ~I'k~ CI~, '~N CITY WILL R.EMO~ SUCH
FENCE kND O~RS ]~REBY INDEmnIFY ~D }{OLD ~ CI~' ~MLESS PROI.~
]~T,T. C~.I~S OF D~AGE TO ~ FENCE ~]CH ~ISE FROM ~'HE CITY'S
~MOV~ OF SUCH F}]NCE %~I~ R_MP~RING, I~{SPECTIN<~, I~ROVING OR IN
A~' WAY SEEKING ACCESS TO
O~';NERS AGUE TO ~I~SE
~MOV~'.NG T~ FENCE.
Job Address:
Lot: 21
BUILDING PERMIT A/PPLICATION
Print or T¥~
Block: ~'~
OUBLIC WORKS
Date:
Phase or Section Number:
Address:
Phone #:
Phone #, ~l ~7~
[] Alteration [] Repair [] Demolition
Contractor: ~ -T~'~ .n~---~_.~ Address: ,~[ J ~
Description of Work to be Done Class of Wor¥ ~ew [] Addition
Area of Building in Square Feet
First Floor Garage
Second Floor Other
NOTICE
This permit becomes null and void if work or construction authorized is not commenced
within 180 days, or construction on work is suspended or abandoned for a period of 180 days
at any time after work is commenced.
I hereby certify that ! have read and examined this application and know the same to be true
and correct. All provisions of laws and ordinances governing this type of work will be
complied with whether specified herein or not. The granting of a permit d~cs not presume to
give authority to violate or cancel the provisions of any other federal state or local law
re uiating construction of the performance of construction.
or zed Agent Print Name
ontractor Mechanical Contractor
Value of Work 7~
to be Performed
GRAY AREA FOR OFFICE USE ONLY
FPMC - 1 (4/94)
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