Fillable City of Irwindale Dedication Paver Application (City of Irwindale)

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City of Irwindale Dedication Paver Application (City of Irwindale)

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The City of Irwindale Dedication Paver Application (City of Irwindale) form is 2 pages long and contains:

  • 1 signature
  • 5 check-boxes
  • 11 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Irwindale

BROWSE CITY OF IRWINDALE (CA) FORMS

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City of Irwindale
Dedication Paver Application
Applicants Name:
Address:
Applicants Phone: Applicants E-Mail:
Individual to be Recognized:
Is the individual deceased? No Yes, date: __________________
Biographical information:
Civic involvement:
Reason for Paver purchase:
Additional Comments:
Size of Paver: 8”x 11” 6” x 8” 5”x 5”
PLAQUE ENGRAVING
Please fill the boxes with the wording exactly as you would like it to appear on the item you selected.
• Punctuation marks such as hyphens, apostrophes, and periods should occupy their own character space.
• Any Symbol is considered one space (Period, Comma, Dash)
• You may also use numbers in the inscription.
• Spacing in between words is considered a character.
ALL CHARACTERS AND LETTERS WILL BE IN FRANKLIN GOTHIC MEDIUM FONT IN CAPITAL FORMAT.
Applicant Signature: __________________________________ Date: _________________
For Office Use
Date Paid (attach copy of receipt): Received By:
Date Received by City Manager’s Office: ___________________
Date Ordered: Date Installed:
SIZE OF
PAVER
ESTIMATED
PRICE PER ITEM
5"x 5"
w/up to 4 lines of text, 14 characters per line including spaces
and punctuation
$30.60 *
6" x 8"
w/up to 4 lines of text, 16 characters per line including spaces
and punctuation
$33.85 *
8" x 11"
w/up to 5 lines of text, 21 characters per line including spaces
and punctuation
$54.50 *
Price includes paver, engraving and shipping
*Prices subject to increase on annual basis*
Please note: We will not be able to order paver until a minimum quantity is met
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City of Irwindale Dedication Paver Application (City of Irwindale)

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Completed 9 July 2021

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