BAS^ BALL
D E PA R T M E N T O F T R A N S P O R TAT I O N S E R V I C E S
A P P L I C AT I O N / P E R M I T F O R S T R E E T U S A G E
/ji/f'S h Zl, ZQI/
Application Date
Application is hereby made to perform the following work activity upon the City and County of Honolulu roadway described below and at the location(s) specified, and at no other place. NAME of roadway and location boundaries on said roadway:
l^eA)2~ BATHFOOM/BAS^ BALL FVNCj^ Sc>c.c^2^ FoN-PSiSf AI^W 3^Asor\/
A / V I " { 0 0 11 4 N ^ ^ D C [ f \ T I V ) ' ^ LIMITS of work area:
□ □
Sidewalk/shoulder Traveling lane:
area: to
to close close &
&
leave leave
open open
"■ Parking lane: Parking meter #(s) Comments:
DESCRIPTION of work to be performed:
□ Engineering Survey □ Routine Maintenance □ Reconstruction Sidewalk/driveway □ Reconstruct/repave Roadway
□ Park commercial licensed truck(s) /^Prohibit Parking □ Occupy the roadway to repair/install / Q( other Td U)APIf'v!^ (J
A)
t
//\)C/
Comments:
DATE{S) AND TIME which work to be performed (inclusively):
2-PI7 SA/VI ' 2P/U
Including: ^ Saturd'ay(s) □ Sunday(s) □ Holiday(s)
This Permit must be clearly visible on the vehicle's dash at the job site. The Agency or Department by requesting and obtaining the vehicle parking permit agrees to indemnify, defend, and hold harmless the Department of Transportation Services, its officers, representatives, and employees from and against any claims, actions, demands, suits or judgements for parking violation fines, loss liability or damages Including claims for property damages, personal Injuries or deaths, and for costs and attorney's fees. The applicant hereby agrees that any agreement heretofore
made or hereafter to be made and the covenants and conditions stated on the reverse side hereof shall be binding upon him, his heirs, personal representatives, contractors and assigns. >x-
A P P L I C A N T:
AY S O
,
(Name of comnany whether individual firm, partnership,
y ! c^poj|)ation, governmental agency, etc.)
i'p>(e y- / — Signature of Requestor
TELEPHONE NO.: (^^ ^f - ^ IS
A P P L I C AT I O N / P E R M I T F O R S T R E E T U S A G E
/ji/f'S h Zl, ZQI/
Application Date
Application is hereby made to perform the following work activity upon the City and County of Honolulu roadway described below and at the location(s) specified, and at no other place. NAME of roadway and location boundaries on said roadway:
l^eA)2~ BATHFOOM/BAS^ BALL FVNCj^ Sc>c.c^2^ FoN-PSiSf AI^W 3^Asor\/
A / V I " { 0 0 11 4 N ^ ^ D C [ f \ T I V ) ' ^ LIMITS of work area:
□ □
Sidewalk/shoulder Traveling lane:
area: to
to close close &
&
leave leave
open open
"■ Parking lane: Parking meter #(s) Comments:
DESCRIPTION of work to be performed:
□ Engineering Survey □ Routine Maintenance □ Reconstruction Sidewalk/driveway □ Reconstruct/repave Roadway
□ Park commercial licensed truck(s) /^Prohibit Parking □ Occupy the roadway to repair/install / Q( other Td U)APIf'v!^ (J
A)
t
//\)C/
Comments:
DATE{S) AND TIME which work to be performed (inclusively):
2-PI7 SA/VI ' 2P/U
Including: ^ Saturd'ay(s) □ Sunday(s) □ Holiday(s)
This Permit must be clearly visible on the vehicle's dash at the job site. The Agency or Department by requesting and obtaining the vehicle parking permit agrees to indemnify, defend, and hold harmless the Department of Transportation Services, its officers, representatives, and employees from and against any claims, actions, demands, suits or judgements for parking violation fines, loss liability or damages Including claims for property damages, personal Injuries or deaths, and for costs and attorney's fees. The applicant hereby agrees that any agreement heretofore
made or hereafter to be made and the covenants and conditions stated on the reverse side hereof shall be binding upon him, his heirs, personal representatives, contractors and assigns. >x-
A P P L I C A N T:
AY S O
,
(Name of comnany whether individual firm, partnership,
y ! c^poj|)ation, governmental agency, etc.)
i'p>(e y- / — Signature of Requestor
TELEPHONE NO.: (^^ ^f - ^ IS
