Application Fee Refund Authority Letter - Excel by gqf61507


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									                                       GRADING PERMIT APPLICATION
                                                     (Available online at
                                        (Permit requests accepted until 4:00 p.m.)
                                                         PLEASE PRINT OR TYPE
STREET ADDDRESS                                                                                            ZIP CODE:
LEGAL DESCRIPTION:                                                                                                    ACRES
TRACT/PARCEL/MB No.                                                                                                   Number
(Include lot, parcel #)                                                                                               of Lots


24 HOUR CONTACT                    Name:                                                       Telephone No.:

ESTIMATED START DATE                                                            ESTIMATED COMPLETION DATE

CONTRACTOR or OWNER / BUILDER:                         CONTRACTOR ID #:                                                              required
Name (Last, First, M.I.)                                                                       Title
Street Address                                                                                                 City
State                                                  Zip Code                                EMAIL
Phone                                                                                 Fax
Contractor's License &                                                          City Business License &
Expiration Date:                                                                        Expiration Date:
                                       (Required unless owner/builder)                                     (Required unless owner/builder)

OWNER:                                  OWNER ID #:                                                                   required
Name (Last, First, M.I.)                                                                       Title
Street Address
City                                                                                State                                      Zip
Phone                                                                    Fax                               Email
APPLICANT: (If different from Contractor or Owner/Builder)                     APPLICANT ID #:                                       required
Name (Last, First, M.I.)                                                                       Title
Street Address
City                                                                                State                                      Zip
Phone                                                                    Fax                               Email
DEPOSITOR:                              DEPOSITOR ID #:                                                               required
ASSUMES RESPONSIBILITY FOR ALL PERMIT ASSOCIATED COSTS - Will receive any deposit/security refunds and invoices for additional funds.

Name (Last, First, M.I.)                                                                       Title
Street Address
City                                                                                State                                      Zip
Phone                                                                    Fax                               Email

                             GRADING PERMIT APPLICATION page 2 continued from page 1
Yardage                                            Cut                        Fill
                                                 Import                     Export
Plan Check #                                                          PERMIT NO.
NOI / WDID #                                                          WQMP APPROVED

                                             GRADING PERMIT CHECKLIST
         1) Grading Permit Application – Completed                    * Reminder- an Encroachment Permit may also be required

         2) Grading and Erosion Control Agreement                     – w/ authority to bind as applicable

         3) Four (4) copies of the approved plan set.
onsite   4) Storm Water Pollution Prevention Plan (SWPPP)                       IF grading disturbs more than 1 acre

         5) Copy of Signed Notice of Intent (NOI)                     IF grading disturbs more than 1 acre

         6) Copy of State Issued WDID# Letter                         IF grading disturbs more than 1 acre

         7) Approved Water Quality Management Plan - (WQMP) - As applicable for projects not approved and / or conditioned           by 7/1/05

         8) Southern California Edison Letter of Non-Interference (SCE NIL)

         9) Permit & Inspection Costs:                            TOTAL
                 a. PW Inspection Deposit :                   $
                 b. Additional Plan Check Deposit :           $                          To bring plan check account current & cover final billings.

                                  Subtotal Deposits :         $

                 c.   Grading Permit Fee:                     $
                 d.   General Plan Fee:                       $
                 e.   Mylar Retention Fee:                    $                          $8.00 per sheet
                 f.   Report Retention Fee:                   $                          $50.00 each
                 g.   1% Cash Security Admn. Fee              $                          amount due equal to 1% of actual CASH security deposited

                                     Subtotal Fees:

         10) Security:                                            TOTAL

                           a. All Cash                        $                           : or
          Note: Select ONE                                                                            (Note: Security Deposits are refundable
                           b. 10% Cash                        $                                          upon completion of work. Written
                               90% Bond                       $                           : or       requests for refund and/or reduction must
           "a", "b" or "c"
                                                                                                     include a copy of the receipt and/or bond
                           c. 10% Cash                        $                                                     and permit.)
                                    90% Ltr of Credit         $

         11) Mitigation Fees:       Need Gross Acres              TOTAL
                a. Kangaroo Rat Habitat                           $
                b. Area Drainage                                  $
                c. Admn. Fee                                      $                       $4.00 ea

         12) FEMA Flood Plain Management                              LOMR-F                         LOMR
                                                                      CLOMR                          Elevation Certificate
_____ 13) OTHER

                                             THE ABOVE LIST IS NOT INCLUSIVE.
                            Please review your conditions of approval for any other project specific
                                             City of Murrieta
                                 1 Town Square • 24601 Jefferson Avenue
                                           Murrieta, CA 92562
                                         (951) 304-CITY (2489)
                                           Fax (951) 698-4509

                                  Depositor Application
  Depositor Name (First, Last):


  Company Name:

  Street Address:

  City, State, Zip Code:

  Telephone:                                             Fax:

  Cell:                                                  Email:

  Tax ID Number:

  Contractor License Number:

  Contractor License Expiration Date:

  Other Information:

The signature below authorizes the City of Murrieta to facilitate the refund and billing process by
transferring monies among concurrent applications to cover processing costs as necessary. The City
will refund fees collected in excess of the actual cost of providing specific services. If additional funds
are needed to complete the processing of your application, the City will bill you. Processing of the
application will cease until the outstanding balance is paid and sufficient funds are available to continue
the processing of the application. The Depositor understands the deposit process as described herein
and that there will be no refund of monies, which have been expended as part of the application review
of other related activities or services, even if the application is withdrawn or the application is ultimately
denied. Additional billings and any refunds will be sent to the depositor of record.

  Depositor Signature:       X


                                                                        Finance Use Only
                                                         Customer Number:

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