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Case #
For office use only:
9'1-cf/ I'
Date of submittal
Submittal chll.cJed
for completeness by:~
APPLICATION FOR PUBLIC IMPROVEMENT PERMIT (pIP)
Applicant (party responsible for completion of all work associated with the
project): }3e1CJA/j4C{Jry!J~/Nflf;# - .5lev~ 4/'cJe/V"
Applicant's Address: J()(J;7 nJ.-rl" ~/\7/ J -s. ~)1"Z, ICp
Applicant's Phone Number:<;!, i:fb-ff., 7f<fJ. ~?t '-I
Identify the type of work to be performed:
~lectrical
Master Electrician (iJ b:'7l?#
,
Master Irrigator;)~J>t/~/,vCR ~
;;;:/pr:frl C-.- _
, or
v-Jrrigation system
Demolition
Structural Contractor
VWood fence
* Structural Contractor
_Masonry fence
* Structural Contractor
_Sign(s)
*Sign Contractor
Facade
Structural Contractor
_Awning
Structural Contractor
Cafe
*Structural Contractor
. _Canopy
* Structural Contractor
Benches
Bike racks
~dscaping
*Landscape Architect/Company (j#Y'Ie..~
,
,K,j
o:\group\deve _ ser\fonns\plan\pipapp.doc
_WatelWay 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:
If 41/J9;J~bIL
Identify the following:
The total valuation of the work: $
~ 7: I'ptJ
,
The total square footage of the site:
;:ex ,l 7 ()
The total linear .feet of water lines crossing under paved road: :7L15 tCi
The party responsible for maintenance: ~r/o/tPPj'77 ,IICl#le,c>a/;1/?/!;T /~~~
Address: 7!B l3.rc{ ~7 ~(17
Phone number: 6 '(5 ~ iZ A.9 L
(ifparty is a group, please provide information for contact person)
Estimated cost of future relocation of improvements: $
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
Location of all public utilities (existing) - dimensioned from right-of-way or back
of curb, material, size
o:\group\deve ~ ser\fonns\plan\pipapp.doc
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 showing the 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
IrrigationIPlumbing 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
permit maY' be revoked at any time at the discretion of the City Officials.
n
I
/~( 2/ ~/7
Date applied
o:\group\deve _ser\fonns\plan\pipapp.doc