HomeMy WebLinkAbout00072191FOR OFFICE USE ONLY
CASE NO.• —
DATE SUBMITTED: * 0 a
SUBMITTAL CyE KE BY:
PUBLIC IMPROVEMENT PERMIT (PIP) APPLICATION��
MINIMUM SUBMITTAL REQUIREMENTS
$150 PIP Permit Application Fee
Attach copies of a facility layout plan, which may include the following:
Location, identification, and dimensions of ROW and pavement edge /curb)
�ocation 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
� sheet ):
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
-dames and scientific)
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
Private utilities plan- dimensioned from right -of -way or back of curb, material, size
one copy of the following:
Indemnity agreements from ab utting fee owners
APPLICANT /PROJECT MANAGER'S INFORMATION (Party responsible for completion of all work associated
with the project):
Name
Mailing Address �,(l Ci?cil.A L��tl City
6do do- ��Qn""
State Zip Code E -Mail Address S. cldrdeoe 7_�:- .r�T
Phone Number g - §71l y::3Z 2 � Fax Number Z
PARTY RESPONSIBLE FOR MAINTENANCE: (if party is a group, please provide information for contact
person)
Name/Group
h
PIP APPLICATION I of 2
PIPAPP 12/31/01
Mailing Address
State Zip Code
Structural Contractor
Phone Number
E -Mail Address
Fax Number
City
IDENTIFY THE TYPE OF WORK TO BE PERFORMED:
L—Electrical Master Electrician
4-irrigation system Master Irrigator �ef9n/ ��i•�L�
_Demolition
Wood fence
_Masonry fence
_Sign(s)
_Facade
_Awning
Cafe
_Canopy
_Benches
Bike racks
landscaping
_Waterway Alterations
_Other (please describe)
*Structural Contractor.
*Structural Contractor
*Sign Contractor
Structural Contractor
Structural Contractor
*Structural Contractor
*Structural Contractor
*Landscape Architect/Company
Design Engineer
Identify party to perform this
*the starred items may not require that structural contractors, sign contractors, or landscapers perform the
work - contact applicable City Departments for determination
IDENTIFY THE FOLLOWING:
The total valuation of the work: $
The total valuation of the signage: $ !1
The total square footage of the site: � Z0 `r1`
The total linear feet of water lines crossing under paved road:
Estimated cost of future relocation of improvements:
PIP APPLICATION 2 of 2
PIPAPP 12/31/01
A 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 Of i ials.
Applicant's signature D e applied
Conditions of Approval:
Authorization of City Engineer
PIP APPLICATION
PIPAPP 12/31/01
Date approved
3 of 2