ENG2024-0039+City_Application+1.26.2024_8.16.40_AM+4021891OF EDAf
O
St. g9" ENCROACHMENT PERMIT APPLICATION
ADDRESS OF PROPOSED PUBLIC USE:
PROPERTY OWNER NAME:
PROPERTY OWNER MAILING ADDRESS:
CONTACT NAME:
CONTACT EMAIL ADDRESS:
Describe the portion of public space, City right-of-way or easement area to be utilized (i.e., overhead space of
sidewalk, 10 foot City utility easement along north property line, etc):
Describe the type of encroachment or use desired (i.e., fence 6 feet by 150 feet, awning 3 feet wide by 7 feet
long, etc.):
------------------DEPARTMENT APPROVALS ---FOR CITY USE ONLY -------------------
Planning Division Approved By ADB# Date
Public Works Approved By Date
Remarks or Comments:
Engineering Division Approved By Date
Certificate of Insurance Verified By Date
Encroachment Agreement sent to City Clerk for recording Date
ENCROACHMENT PERMIT# ISSUANCE DATE
BUILDING PERMIT # RECORDING #