HomeMy WebLinkAbout00070788FOR OFFICE U E ONLY
CASE NO.: r
DATE SUBMITTED: O
SUBMITTAL CHECKED BY: /
PUBLIC IMPROVEMENT PERMIT (PIP) APPLICATION
MINIMUM SUBMITTAL REQUIREMENTS
Attach 4 copies of a facility layout plan, which may include the following:
v 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
If applicable, the facility layout plan must include the following (these may be drawn on separate sheets):
✓ A signage plan - include dimensions of sign (s), location from back of curb, materials, elevation drawing
N Nt Drainage and/or erosion control plan
01 N - Proposed waterway alterations with supporting drainage report
✓ Landscape plan showing the location and type of plantings (existing and proposed, both common names and
scientific)
4 A The cost estimate for relocating any public facilities associated with the work
_ f>c An electrical plan
✓ Irrigation/Plumbing plan (must be sealed)
✓ A Structural plan showing details with anchoring, attachment, and material description (must be sealed)
t k Private utilities plan- dimensioned from right -of -way or back of curb, material, size
, ttach one copy of the following:
agreements from abutting fee owners
APPLICANT/PROJECT MANAGER'S INFORMATION (Party responsible for completion of all work associated with
the project):
Name 3rokv%5oh �h.,cti 1. hC..
Mailing Address P . 0 . Q ay p City je IM C. 0
State _N_ Zip Code 7 b 6 34 E - Mail Address
Phone Number I I f - 6 Z,S - 2 1 Z Fax Number el 1,S - 6 Z S - 3 6 7
PARTY RESPONSIBLE FOR MAINTENANCE: (if party is a group, please provide information for contact person)
Name /Group 5 4-v h e rn r t -f - H 0 '. e (+SS o c c ,-+, o h
Mailing Address ?- 0. 6"� a O
State __C�_ Zip Code -? 6 8 3
Phone Number q / S - 6 7"S_ y Z Fax Number
IDENTIFY THE TYPE OF WORK TO BE PERFORMED:
Electrical
i rrigation system
Demolition
Master Electrici
city C o Iew.
E -Mail Address
IIS- 6Z5- 30z
Master Irrigator T"r(Nc c ::rr n R 2"
Structural Contractor
PIP APPLICATION I oft
PIPAPP.DOC 3/23/99
LLEGE STAHON I
FOR OFFICE USE ONLY
CASE NO.:
DATE SUBMITTED: O
SUBMITTAL CHECKED LI
l `' C ' U
PUBLIC IMPROVEMENT PERMIT (PIP) APPLICATION
MINIMUM SUBMITTAL REQUIREMENTS
Attach 4 copies of a facility layout plan, which may include the following:
y" 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
If applicable, the facility layout plan must include the following (these may be drawn on separate sheets):
✓ A signage plan - include dimensions of sign (s), location from back of curb, materials, elevation drawing
__ N Lk Drainage and/or erosion control plan
01 lr Proposed waterway alterations with supporting drainage report
✓ Landscape plan showing the location and type of plantings (existing and proposed, both common names and
scientific)
4 A The cost estimate for relocating any public facilities associated with the work
An electrical plan
✓ Irrigation/Plumbing plan (must be sealed)
✓ A Structural plan showing details with anchoring, attachment, and material description (must be sealed)
I�t 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
APPLICANT/PROJECT MANAGER'S INFORMATION (Party responsible for completion of all work associated with
the project): \ -
Name
Mailing Address p. b . Q ey O y City e b a w► 6.-
State �� Zip Code 7 b 6 34 E -Mail Address
Phone Number I f - b 2-.5 - 2. 1 Z � Fax Number g 1 J_ b Z S - 3 67
PARTY RESPONSIB I LE FOR MAINTENANCE: (if party is a group, please provide information for contact person)
Name /Group h e o %, e A"SS a C c F f o A
Mailing Address � � fl. City C J e k%1% o 9%
State _C �_ Zip Code - ) 6 8 ? � E - Mail Address
Phone Number I / S - 6 ZS - Z) Z 4- Fax Number I ! S - b Z S - 36 7 Z
IDENTIFY THE TYPE OF WORK TO BE PERFORMED:
Electrical
�I gation system
Demolition
Master Electrician 7
Master Irrigator Prrwc c ::rr-r, R� _ J O N r��► c
Structural Contractor
PIP APPLICATION i of 2
PIPAPP.DOC 3/25/99
r
rrx,4, I
VWoo& fence
✓Masonry fence
— Sign(s)
Facade
Awning
Cafe
_Canopy
Benches
Bike racks
✓Landscaping
Waterway Alterations
v6ther (please describe)
*Structural Contractor J a V* A e S
*Structural Contractor J=�v ,cff - �► S
*Sign Contractor
Structural Contractor
Structural Contractor
*Structural Contractor
*Structural Contractor
*Landscape Architect/Company g - 6 4t- 2 w+�
Design Engineer
K;osk
Identify party to perform this work: 4:' e e -ff W J ( 5
*the starred items may not require that structural contractors, sign contractors, or landscapers perform the work -
contact applicable City Departments for determination
ENTIFY THE FOLLOWING: oa
The total valuation of the work: $ I 010 -°
The total square footage of the site: Sa q The total linear feet of water lines crossing under paved road: 0
Estimated cost of future relocation of improvements: $ o
I hereby verify that the information contained in this application is true and complete, to the best of my knowledge.
understand that the City has the authority to inspect the work to be conducted within the public right -of -way at any time.
also ug&qtand that this permit may be revoked at any time at the discretion of the City Officials.
3 - -01
p dssiginature Date applied
Conditions of Approval:
Authorization of City Engineer
PIP APPLICATION
PIPAPP.DOC 3/25/99
Date approved
2 of 2