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6. ldentify the accessibility features and equivalent facilities that Wltt be brought into compliance with the <br />latest edition of Title 24 as a part of this project and an estimate of thecostof eachitem: (Documentation <br />may be required) <br />Total <br />e <br />Total: <br />8. Petitioner must be tho legal property owner or his/her legal representative <br />I certify that the above noted information is true and correct. <br />! Legal Property Owner E ArchitecUEngineer ! Contractor E Other <br />Print Name: Phone No. <br />Signature Date: /0 -6 2/ <br />Approved by <br />Accessible Features lo be Made Accessible Cost of lmprovement <br />a. Entrance <br />$E ooor E Landing ! Stairway/Steps E Ramp <br />b. Path of Travel <br />s! Path of travel from accessible parking to the building entrance <br />and area of remodel <br />$E Path of travel to sanitary facilities / public phone / drinking <br />fountain <br />E Path of travel from the public way to the building entrance $ <br />$c. Sanitary facilities ( Floor no ) <br />d. Public phone(s)$ <br />$e. Drinkingfountain(s) <br />f. Parking <br />$g. Signage & Alarms <br />$i. Other: <br />$ <br />Accessible Featuros Not to be lmproved Cost of lmprovement <br />a $ <br />$ <br />$c <br />$ <br />Rev 05120t2021 <br />Date <br />Page 2 of 2 <br />\- <br />\ <br />7. ldentify the accessibility features that WILL NOT comply if a request for unreasonable hardship is <br />granted. Provide an estimated cost of compliance for each item: (Documentation may be required) <br />av <br />Address: <br />b. <br />FOR AGENCY USE ONLY