20170321153111.pdfENCROACHMENT PERMIT APPLICATION
ADDRESS OF PROPOSED PUBLIC tJSE:
PROPERTY OWNER N
90,1, IVD
I W10 -le I
PROPERTY OWNER MAILING ADDRESS:
CONTACT NAME: 4/e"?!5 . . . . ........... . . .............. PHONE
CONTACT' EMAII, ADDRESS:
Describe the portion of public space, City right-of-way or easement area to be utilized (i.e., overhead space of
sod walk, 10 foot City utility easement along north property line, etc):
L, ox flo--l'oA V h) AJ-4, -6?z9A)
Describe the
long, etc.):_
of encroachment or use desired (i.e., fence 6 feet by 150 feet, awning 3 feet wide by 7 feet
---------------.._-DEPARTMENT APPROVALS ---FOR CITY USE ONLY ----
Planning Division Approved By ADB#
Public Works Approved By
Remarks or Comments.
Engineering Division Approved By
Certificate of Insurance Verified By
Date
Date
Encroachment Agreement sent to City Clerk for recording Date
ENCROACHMENT PERMIT#2AL2AUp�ISSUANCE DATE
BUILDING PERMIT# RECORDING # '�Qij (")?L Lj—