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Case # ~ M
Date of submittal ~ `t
Submittahthe~k~d L
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APPLICATION FOR PUBLIC IlvIPROVEMENT PERMIT (PIP)-~
Applicant (party responsible for completion of all work associated with the
project): ~&~t~ `~~~ i
Applicant's Address:. ~5®1 ~~,.~~'~~ ~~~'~4--~ `~r~C ~~~®~
Applicant's Phone Number:. (~,®~'~ ~ ~'~ _ ~ ~ ~~
Ide/ntify the type of work to be performed:
~/ Electrical Master Electrician ~~ ~~ /~. ~ ZL ~ri2 ~ G
Irrigation system Master Irrigator
Demolition Structural Contractor
-Wood fence
-Masonry fence
-Sign(s)
Facade
-Awning
Cafe
-Canopy
Benches
Bike racks
* Structural Contractor
*Structural Contractor
*Sign Contractor
Structural Contractor
Structural Contractor
* Structural Contractor
*Structural Contractor
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Landscaping *Landscape Architect/Company
Waterway Alterations Design Engineer
-Other (please describe)
Identify party to perform this work:
*the starred items may not require that structural contractors, sign contractors,
or landscapers perform the work -contact applicable City Departments for
determination
State whether applicant intends to pursue City participation in the funding of
these improvements and describe:
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Identify the following:
The total valuation of the work: $
y a~
The total square footage of the site: $~~ ~ P~g ~ ~ ®~/q. ~ ~ ~. ~ 21®~~ ~l a ~(~~ ~ ~~~•
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The party responsible for maintenance:-. _~,~P,l~~e~ ~ ~Y1~~
Address: d ~ ~~tA~i ~ r ~,'~ . ~
Phone number:_~`~ a ~~ ~„~'
(if party is a group, please provide information for contact person)
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Estimated cost of future relocation of improvements:$ 1C3~ ~'
Attach 4 copies of a facility layout plan, which may include the following:
Location, identification, and dimensions of ROW and pavement edge/curb)
Location of all proposed improvements
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Location of all public utilities (existing) -dimensioned from right-of--way or back
of curb, material, size
If applicable, the facility layout plan must include the following (these may be
drawn on seperate sheets):
A signage plan -include dimensions of sign (s), location from back of curb,
materials, elevation drawing
Drainage and/or erosion control plan
Proposed waterway alterations with supporting drainage report.
Landscape plan showingthe location and type of plantings (existing and proposed,
both common. names and scientific)
The cost estimate for relocating any public facilities .associated with the work
An electrical plan
IrrigationlPlumbing plan (must be sealed)
A Structural plan showing details with anchoring, .attachment, and material
description (must be sealed)
Private utilities plan- dimensioned from right-of--way or back of curb,. material, size
Attach one copy of the following:
Indemnity agreements from abutting fee owners
I hereby verify that the information contained in this application is true and complete, to
the best of my knowledge. I understand that the City has the authority to inspect the work
to be conducted within the public right-of--way at any time. I also understand that this
pemay be revoked at any. time at the discretion of the City Officials.
~~"~I°~~
Date applied