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3usCW Case No.: 03 — /L
Date Submitted:
PUBLIC IMPROVEMENT PERMIT (PIP) APP
MINIM MM SUBMITT L I3E (DUIREMENTS
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$150 PIP Permit Application Fee j cc �' 0
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 -- '? l�
❑ 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
❑ 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
❑ Irrigation /Plumbing plan (must be sealed)
❑ A Structural plan showing details with anchoring, attachment, and material description (must be sealed)
❑ Private utility, plan- dimensioned from right -of -way or back of curb, material, size
Attach one copy of the following:
❑ Indemnity agreements from abutting fee owners
MANAGER'S INFORMATION (Parry responsible for completion of all work associated with the project):
Name Alb Ue- _/ E -Mail
Street Address `� o ( L,17`
city 4-
Phone
State
Zip Code 77��
Tom'
Fax Number 74 �( 10 3
PARTY RESPONSIBLE FOR MAINTENANCE (if party is a group, please provide information for contact person):
Name /` , I-lo J 1 E -Mail
Street Addr9ps B e
City - State Zip Code
Phone Number Fax Number _
IDENTIFY THE FOLLOWING:
The total valuation of the work: $ y�ODp
The total valuation of the signage: $ L222
Estimated cost of future relocation of improvements: $
The total square footage of the site:
The total linear feet of water lines crossing under paved road:
1- Aug-02 1 of 9
IDENTIFY THE TYPE OF WORK TO BE PERFORMED:
❑
Awning
Structural Contractor:
❑
Benches
Number of Benches
❑
Bike racks
Number of Bike Racks:
❑
Cafe
*Structural Contractor:
❑
Canopy
*Structural Contractor:
❑
Demolition
Structural Contractor:
❑
Electrical
Master Electrician:
❑
Facade
Structural Contractor: /
Ole o NS
❑
Irrigation system
State Licensed Irrigator:
❑
Landscaping
*Landscape Architect/Company:
❑
Masonry fence
*Structural Contractor:
❑
Sign(s)
*Sign Contractor:
❑
Waterway Alterations
Design Engineer:
❑
Wood fence
*Structural Contractor:
❑
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
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.
d o j 2 el l e
Applicant's signature
Date applied
Conditions of Approval:
Authorization of City Engineer
Date approved
1- Aug-02 2 of 2
%"'J "'Y fit COLLLGL 'YfA *0N
ti GUSTOMB REOEIh A *f
Oper: SSTAHLEY Typc: CT Drawer: i
Date: /03 00 Receipt no: r'2j55
5/1O kn
Descri Lion quantity Amount
203 500122
PL PLANNING AND ZONING
1.00 ; I:,b.00
ROBERT B RUTH
FOX RUN CONDO
SS
Fender detail
+„K PERSONAL 4466 $iW A
Total tendered 15010ia
lotal payment. 5150•N0
Trans date: `,/1`1103 '!'ime:
THANK YOU