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6 ldentify th6 accessibility features and equivalent facilitiss that wlLL be brought into complianc€ with <br />the latest edition of ritle 24 as a part of this projecl and an estimate of the cost of Bach item: <br />( Documentatbn may be required) <br />Accossible Featurss to be Made Accessible Cost of lmprovomont <br />a. Entrance <br />! ooor E Landing I Stairway/Steps E Ramp $ 1,000 <br />b. Path of Travel N/A. ln complia nce <br />f] Palh of travel from accosslble parklng to th€ building entrance <br />and area of remodel 5 <br />E Path of travel to sanitary facilities / public phone / drinking fountain $ <br />! Path of travel from the public way to the building entrance $ <br />c. Sanitary facillties ( Floor no.)s 9,000 <br />d. Public phone(s)$ r.t/n. ruot provided <br />e $ ru/n. uot provided <br />f. Parking $ ru/n. tn compliance <br />g. Signage & Alarms $ n/n. tn complia nce <br />i. Other:S ru/n. tn comoliance$ ro,ooo <br />7. ldentify th6 accessibility features that WILL NOT comply if a requesl for unreasonable hardship is <br />granted. Provide an estimated cost of complianc€ for each item: (Documentation may ba required) <br />Accessible Featuros Not to b6 lmproved Cost of lmprovement <br />a Not applicable D <br />b $ <br />c.$ <br />sTotal: <br />E. Petitloner mu3t be ths legal propsrty owner or hls/her legal repressntatlve: <br />I certity that the above noted information is true and conect. <br />I Legal Property Owner Xtucnitecuengineer ! Contraclor fl other: <br />Print Name:RogEcr faE E CE , D Fs t o^t l./r/ar. phone No.Qt4) sz-qqoo ny1 <br />Address: <br />Signature:Date 3 701 <br />R€v:1/9/20'17 <br />FOR AGENCY USE ONLY <br />Ddnking fountain(s) <br />Total: <br />Approved by:Date: <br />Page 2 ol2