HomeMy WebLinkAbout12030 CITY OF GLENDALE
/-.- APPLICATION FOR PERMIT TO PERFORM WORK ON PUBLIC RIGHT-OF-WAY
CONSTRUCTION ENGINEERING DIVISION N.° 12030
Iiitl PERMIT NO: �,//j� /(+ �// / y/., �yy 9
('I $F$'i�S�' PROJECT NAME: Oyr, �+ ,Z ,f ,XAi2 3 '/�//,Il��t LI ,iv , DATE ISSUED: 1� —/69?..y�
•
PROJECT ADDRESS `j "� )0 n- .4t f A.AA DATE EXPIRES: OLcoo
QUARTER SECTION
L
DATE ACCEPTED:
Address /� 1'€ l _ JA4 [re hh 647d V y DDiii z
&9 t 0
r trator Address
\ilik--19X13
• trades License No. Daytime Phone 24. Emergency Phone Pager Phone
/3`7� 04,, -58C� -alai ( ` 410 7- 7Lrn) h@L31Y 220/
on the revserse side of permit,end understand ust Ee dare n aneN WI 1 o theCity of Galeand the
Applicant's Nameels
•nature
jam— _S / l X — _
D ..per ` y� Adtress _ - ... - ' _ .
/ l..,, -v �d I `: pp: I (G./of 143/I') r4 . ;3'/ (1.(.t , L. Av 8.x/1
WATER UNES LF Die. LF Die. SANITARY SEWER LF Dia LF Dia. MISC EA Manholes
LF Die. LF Dia ALF Die LF _Die. _-EA Fire Hydrants
sura 0 Cash Bond A4naunt Name/Address of person to return bond to:
❑ Surety Numher
I 11k bAD2;J'. Comments:
UTILITY PERMIT FEE UTILITY PERMITS QUANTITY UNIT PRICE BASE FEE $ 50.00
TRENCH(RAN) PAVED LF @.$0.15 AF $
TRENCH(RAY)UNPAVED }LF @,$O.IOAF $
PITS EA @$10.001EA $ .
STREETLIGHTS 'i-EA @ $50.00/POLE $ •
TOTAL $
STREET PERMIT FEE STREET IMPROVEMENT PERMITS QUANTITY ::'UNIT PRICE BASE FEE $ 50.00
PAVING SY -@ $0301St' $
MANHOLES ... . EA @ $4000/EA $ '
CURB AGLITTER A LF g$0.20 AF $
VALLEY GUTTER SF @ $0.08/SF $
SIDEWALK SF @ $0.05/SF $
•
•
SIDEWALK RAMPS SF @ $0.10/SF $
. PRIVATE RESIDENTIAL DRIVEWAY EA @ $25.00/EA $
DRIVEWAY SF @ $0.10/SF $
—
CURB CUT EA @ $200.00/EA $
CATCH BASIN EA @ $40.00/EA . $
TOTAL: S ' Z
10
W/S PERMIT FEE WATER I SEWER I STORM DRAIN PERMITS QUANTITY UNIT PRICE BASE FEE $ 50.00
WATERLINE LF @ 30.80 AF $ —'
le
��/////(J1]]]]'''''777T7
No
SEWER LINE / LF @ $0.60AF $ . V 70 U
CO
STORM DRAIN LF @ $1.00 AI $ 0
IRRIGATION LF @ St.00A.F $
MANHOLES EA @ $40.00/EA $ JJ
WET TAPS ' EA @ $300.00IEA $ • L&6IL L
TOTAL: $
TOTAL PERMIT.FEE $ ) 7cty