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00071605FOR OFF M USE ONLx U~ 0 L vX cxa: . DATE SUWrII1TBD: D suBmrrTAL CHECIw BY: -D- 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 2of2