ENC2005-00003PUBLIC Wl,....5 DEPARTMENT RECEIPT
FRective JWy 1, 20114 r~ f
Cit_v Clerk PUBLIC WORKS FILE N0. t- ^ V' ~ ~ Or~ ~O(,..,}.~~ ~,U~
PROPERTY ADDRESS ~ I ~ • V V " ,
Please collect & recefp[ for the f Ilnwinp monies:
ROACHMENTPERMIT'
4722 Applfution Fee
Non-Ut01ty Facroaehmcnt Permit (f268.00)
Mimr Encroachment Permit <SS,DOO (559.00)
ResldenNal Streef101Mr Areas
flan Check Deueslt 2% of Eaefnecr's Falfmate
2203 Cash D l (4% of EoBr. RaY)IS5011 m1e/510.000 maxi
4722 Nan Check & Impeellon Fee (Non-Utility)
EttBr.Est.<5250,000
(13%af FNGREST.)
220:1 Fn r. Fat. >5250,000 (Deposit 8 % of RnBr. Fati.K30,00D mtn)••
4722 lltlllly <S100,000
MlWmmt Charxc Pcr Location
CondWts/Pipelfms up to 500 Feet (5180.00)
(52.25IR)
Above 500 IJnear Fect (SL35IR)
ManMka/VaWWF4c. ff125.00/ea)
PWc $eURemovnl (5125.001[x)
Street Tree Plantinp/Itemeval (5129.00/ea)
!203 Utllity>Sifq,000 Actml Cos[+211%••
4760 Stan Catoieer Permit (5125.00)
4760 Protect Plaru & Specifua/brt ProJcct No.
4760 Standard SpeeVicatiottc & UeWln (Sl/P8 f15_SIVRk)
4760 C ' s of EtrBineertn8 Maps & Hans
Aerial Not 24" x ~" (SS2.W)
Aerial PAnt 8 12" x 11" (f2i.00)
Ma and Plane 24" x 3fi" (58.00)
4722 Pemltlea: FaOure to restore public improvement (5100/Glendar Day) tM.d rn. s.r.tt_vaxtol
4722 Petwllks: Failure to eorrnct umafe emallliom (5100/Cakrtdar DAy)
I 4'27 tnr 1.:.,. Adtuemmt (5775.001
4722 Parcel Ma (4 lot or l.erc) (52,400.011+S35Ant)
4722 F'ina17'ract Mop IS or Morc Lot) (f3.20U.011 + 5351bt)
4722 Ccrtifiutc of Compliance (5613.W)
4722 Certificate of CorreclMn fS37fi.180
d722 Notary Fee ( r sfRoxture) (510.00)
d722 Vaeatkn of Public Street & Fircemenn (S2.tM,nta1
4722 Avttament SeBrtglion or Reapponienment
Flrxt Spilt
(5675.011)
Each Addiliorul Lot (52011.00)
4721 Storm Drairta8e Arca Fee Per Acn (R•1 52,060)
f M Wtl-Res, 52.318)
(All Other. SZ 575)
4920 Parkland Dedication F'ec (75%125% Due Upon Cert. of Occupancy)
511.7424 PosuRc
TenFmc
6728 Imersccdon Tum Count (Twn•Hour Count) (574.25)
4728 Interxee/ion Turn Counts la.m. er p.m. akc) (5145.00)
4728 TmR[c Flox Ma (Dally TraRc Vohuresl (531.0U)
4728 Ca 11 TmRc Model (FWI Sc AtaetazrtenU IAnuaD
4728 Ca 11 TnRte Model (Reduced Scope Assexarem) (Actual)
4728 Siltrtxl TirWnR IWarmation (S67JIIr)
4271 Truck Permit (S1fi.00/per trip)
4728 No Parking SiRnc (Sllcxch or 525/100)
OTHER
OF APPLICANT
NAME OF'PAYOR `._}t-
ADDRESS
••Actual Cost Plus 20% Overhead
FOR
CITY CLERK
ONLI'
TOTAL S ~ ~•/ • ~~
~•~~ ~ ~ J ~0~"- PHONE
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