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0007168617 EASEMENT DEDICATION SHEET (To be filled in and submitted with construction plans and specifications for preliminary review) (0 / -~qo BE COMPLETED REQUESTED' BY: SPECIAL INSTRUCTIONS: (City Department and Name of person to Contact) ACCOUNT NO. ~Ool _ t_{ WD `S7 O U (For ordering title work, appraisals, etc.) TYPE OF EASEMENT: Public Utilities (PUE) STAFF EXT. -~4 58 PROJECT NO. N& Temporary Blanket PUE (prior to building permit) REVIEW AND APPROVAL REQUIRED/GIVEN BY THE FOLLOWING DEPARTMENTS: Approval Required By: Electric Approval Given By: Electric Water/WW (please initial) Water/WW Asst. City Engineer. Asst. City Engineer METES & BOUNDS DESCRIPTION CHECKED FOR CLOSURE BY: (City Staff - Name/Dept.) THIS SECTION TO BE COMPLETED BY APPLICANT PROPERTY OWNER(S): Gregorv J. and Cindy A. Skvpala (Names must be exactly as they appear on the deed) ADDRESS: 2700 W. 16th Ave. #313 PHONE NUMBER:-806-354-0182 Amarillo, TX 79102 ALL LENDERS (Please furnish copies of all lien documents): Caldwell Bank (A Branch of Central Bank) (Names and Addresses) P.O. Box 149, Caldwell. Texas 77836 attn: Jamie Lander IF OWNER IS A CORPORATION, PARTNERSHIP, OR JOINT VENTURE (also see #4 below): 1. State of Incorporation/Registration 2. Partners' Names (if applicable) 3. Person Authorized to Sign (Name and Title) LEGAL DEPARTMENT MUST BE PROVIDED WITH THE FOLLOWING: 1. A copy of a recent (within 90 days) deed or title insurance policy showing the names of the grantors/owners; and 2. For unplatted property, a signed, sealed and dated metes and bounds description and a diagram of the property showing the location of the easement; or 3 For platted property, a copy of the plat showing the lot, block, subdivision, and recording information. 4. For blanket easements, a signed, sealed and dated metes and bounds description and a diagram of the property. 5. Corporate or partnership owners must furnish a copy of a corporate resolution or other proof of authority to sign on behalf of the corporation, partnership, or joint venture. 6. Name, address and phone number of person who is to receive the easement and be responsible for getting it executed: re r~ Sky o _ ( n Any land acquisition resulting from Capital Improvement Projects requires a meeting with the Legal Department. blc:ldocume-1lbgeorgeVocals- I hemplgwviewerleaseme-I.doc 8/01/00