HomeMy WebLinkAbout00071605FOR OFF M USE ONLx
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. DATE SUWrII1TBD: D
suBmrrTAL CHECIw BY:
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PUBLIC ED"VROVEMENT PE (PIP) APPLICATION
M]NVAUM SUBMITTAL REQUIREMENTS
Atta& 4 copies of a fatality La►mt nbw, wbKk ~Y dude the foHowiag:
Location, iden0cadon, and dimes of ROW and pavemcut edge%urb)
Location of all proposed improvements
Location of all public utilities (aasbng) - dmumsioned from right-of-way or back of curb, n aterial, size
If pticablc, the fadik layoat plan mast monde the following (these may be drawn on separate sheets):
A Agnage plan - include dimensions of s*u (s), location from back of curb, ma lmuls, dwa m ram*
Drainage and/or erosion cordrd pha
N Proposed waWrmy ahmAoos wAh st>p w ft drainage report
Landscape plan sowing the location and type of plantings (existing and proposed, both common names and
scientific)
v The cost estimate for rig any public ficilmes associated with drys work
N An eleaRad plan
Sftu town (must ~ and materW descciptioa (must be seated)
PIA A A Structwat tural plan slowing details with an&oring ,
Private utilities plan- dimensioned from right-of-way or back of curb, mOxial, size
Attach one copy of the Wowing:
inkmnity aereemems from abumm fix owners
_ APPLICANT/PROJIXT MANAGER'S INFORMATION (Party responsible for completion of all work associated with
tdble Name a ~d1JJC~(1
Mailing Address Ab D t G a
state Zip Code 5 D -1 B MWI Address a
Phme Number U 1 ` 1 "i"ce Fax Number 1 `'i Q
PARTY
NWa
FOR MARTJ MSMMM (if party is a BmmrR please; pwva& WAMuxbm for aontad person)
State ~rr zip Code lq4r'-)q
Phone Number 1513),5(7 ` I t q C Q F=Nugw
IDENTIFY' THE TYPE OF WORK TO BE PERFORMED:
I~Elecww Master Flecttician
aftrwb-on system master Imgator L
NInemditiatt' r, struc ww Contractor
E-Mail Address
L6o) 7::5o- 5L3c\l
M AnUCATTQN n aft
NPAPP rite: i nim
Pi ;ood fence
OLM.my
°)lA-Facade
y
~f
Banclics
Bike racks
v ~~P
aterway Alterations
other (plee dwmbe)
*Struch,nd Contractor
*saucbnll Contractm
*Sig1k Cauftactw
structural Contractor
struchual Contracts
*Savdmd Contractor
*Shuctural Cow
*Landscape ArchhactQmpany LMLIAP::~= bWO n+ 1AC.
Design Engineer &-Off&QatA-'0
Mat* party to perform this work
swr M items may not mgWre that structu W moors, sign condwctors, or landscapers perpno die wo& -
cantaa apph"Ak City Depm me &for dew
IDENTIFY THE FOLLOWING:
Tire total valuation of the work: S
The total square footage of the site:
The total linear feet of water lines crossing under paved
Estimated cost of future relocation of rovements: $
hereby verify that the insocmadon coatainod in this appluation is troe and cow to the best of my bwwledge-
-
fire City has the authority to kq)cd the work to be conducted within the public right-of-way at any time
that this permit may be revoked at any time at the discretion of the City Officials.
ApplkaWs ~ Date lied
Condifi= of App
kuffimization of City B*inoer
PIP APMWAMN
DAD ADO A!V"!Al' AHf
Date approved
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