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APPLICATION FOR OFFICF USE ONLY ` g Case No.: - / COLLEGE STATION Date Submitted: 02" 1 3-04-1 PUBLIC IMPROVEMENT PERMIT (PIP) APPLICATION MINIMUM SUBMITTAL REQUIREMENTS ❑ $150 PIP Permit Application Fee 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 ❑ 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 Ji (POOCIMUIP APPLICANT /PROJECT MANAGER'S INFORMATION (Party responsible for completion of all work associated with the project): Name -� 1 e7 li/o /jX, /rAct j W /L i Weill a seer lidn E -Mail ivd /sk, P 71z?`vr v- e / Street Address q 043 f c.-'Jh 161e-t Co uc City ?'v /�N f State T x Zip Code r T 675 Phone Number `f 7 ! 6 7'7 1 Fax Number PARTY RESPONSIBLE FOR MAINTENANCE (if party is a group, please provide information for contact person): Name ( w'r/`I // (3 A E -Mail ( .:e -eq / ',) Street Address 9c ei a /A/74T C'� e-7 City 1 - 3/ ' je riz Ten State T Zip Code b+ Phone Number /° 9 G 7`71V) Fax Number IDENTIFY THE FOLLOWING: The total valuation of the work: $ The total valuation of the signage: $ �,Y 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 2 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: QZ] Irrigation system State Licensed Irrigator: piirrP l friaa - 0'!1 E Landscaping *Landscape Architect/Company: / r ye 7 ❑ 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. Applicant's signature Date applied o ditions of Approval: 3) I Authorization of City E • ineer Date approved 1- Aug -02 2 of 2