Stanford University Medical Center's four-year quest to get Palo Alto's permission for a massive expansion of its facilities glided past the finish line Monday night when an enthusiastic City Council voted to approve what members routinely say is the largest development project in the city's history.

In a series of 8-0 votes (Councilman Larry Klein recused himself) that several members called the most important the council will make in many years, the council paved the way for Project Renewal -- a dramatic expansion of Stanford's hospital facilities that will add 1.3 million square feet of new development to the city.

The $5 billion project includes building a new Stanford Hospital & Clinics building, expanding the Lucile Packard Children's Hospital and making various upgrades and renovations to Stanford School of Medicine buildings and clinics.

The tortuous approval process kicked off in 2007 and included 97 public hearings and more than two years of tense negotiations between the city and Stanford over a development agreement that would allow the hospitals for far exceed local zoning regulations. Though the city and Stanford initially clashed on a number of issues, including revenue guarantees, new housing and transportation impacts, the expansion project picked up momentum, along with the council's support, over the past year.

Councilman Greg Scharff said he was amazed by the way Stanford, the city and the greater community pulled together on the project. He praised the health care benefits Project Renewal will bring to the city. His colleagues agreed and backed Scharff's motion to grant the project environmental clearance.

"It's probably going to be the most important that we'll make as a City Council in a long time," Scharff said shortly before the 8-0 vote to approve the environmental-impact report. "I think this will benefit the community for generations."

Other council members shared his enthusiasm. Vice Mayor Yiaway Yeh called Monday's meeting a "momentous evening," and Councilman Pat Burt praised the dramatic change in tone in the negotiations between Stanford and the city, saying the discussions lay "an excellent foundation for future relationships." Councilwoman Gail Price said the project is "complex," "intense" and "forward thinking" and that she considered it a "pleasure to be a part of this process."

Councilman Greg Schmid put it most succinctly: "It's a night for celebration in Palo Alto."

More than 100 people, including a handful of past and present mayors, dozens of doctors and patients and one legendary San Francisco 49ers quarterback, packed into the Council Chambers at City Hall for the project's final public hearing. Their message to the council was clear and nearly unanimous.

"As a resident of Palo Alto, as someone who for generations now -- for my children and probably their children -- have been beneficiaries of this hospital, I urge you to approve this project tonight in a unanimous fashion," said former 49er Steve Young, a member of Stanford Hospital's board of directors, echoing the comments of almost every other speaker.

East Palo Alto Mayor Carlos Romero also voiced his city's support for Stanford's expansion. Though the East Palo Alto council had concerns about the project's traffic impacts, these concerns were assuaged by last-minute negotiations between East Palo Alto, Palo Alto and Stanford. The hospitals had agreed to provide $200,000 to the city for improvements to University Avenue.

Romero cited the Sunday morning shooting in East Palo Alto, in which an infant was killed and his parents wounded. Romero noted that the parents were taken to Stanford Hospital for treatment. The boy's mother was released today.

"Had the Stanford University hospital not been that close, indeed we may have lost another person," Romero said.

The council's votes pave the way for Stanford to launch the next phase, which hospital officials say will require an investment of about $5 billion over the next 30 years. The goal is to upgrade aging facilities, add beds to both the main and children's hospitals and seismically retrofit all the facilities to comply with state law.

The new Stanford Hospital would add 144 beds to its hospital for a total of 600. The Children's Hospital would raise its bed count from 257 to 361. Christopher Dawes, CEO of the Children's Hospital, told the council that these expansions are sorely needed given that both hospitals currently turn patients away because of insufficient capacity.

Both hospitals would also add a slew of patient-friendly amenities, including expanded, family-friendly rooms at the Children's Hospital and a "medicine garden" on the promenade of the new Stanford Hospital. The design of both hospitals had already been endorsed by the city's Architectural Review Board, which held 29 public hearings on the various elements of the expansion project.

The city's Planning and Transportation Commission also backed the project last month over a series of unanimous or nearly unanimous votes.

Commissioner Eduardo Martinez said the planning commission has some concerns about the expansion, including the potential impact of 2,000 new workers on local housing and the Palo Alto Unified School District. Commissioners also suggested that Stanford create a historic-restoration fund to compensate for the proposed demolition of the hospital's "Stone Building," which was designed in 1956 by Edward Durell Stone.

Despite these reservations, the commission unanimously backed the project and recommended approving all the environmental documents and the proposed development agreement between Stanford and the city. The commission also approved changing the city's Comprehensive Plan to create a new "Hospital District" tailored to the needs of the new facilities.

"Stanford Hospital is like nothing else in our city and it makes great sense for there to be a district that deals with the kind of construction that is completely tied to the programs that it houses," Martinez said. "There's a lot of exceptions to the way we build for a hospital project that a Hospital District ... will address."

The environmental study for the project identified 41 "significant" impacts of the project, all but 12 of which could be mitigated to a less-than-significant level. But the project would still increase traffic congestion at several Menlo Park intersections, burden the immediate area with air pollution and require removal of 62 trees. The report also notes that some impacts, including air pollution and noise during construction, cannot be fully mitigated.

Stanford has offered Palo Alto an expansive package of benefits and mitigations to offset these impacts and compensate the city for allowing it to exceed zoning regulations. The hospitals plan to but Caltrain Go Passes for all hospital workers and provide $7 million in health care programs, $12 million for climate-change programs; $3.4 million for pedestrian and bicycle connections; $23.2 million for housing programs and infrastructure; and an upfront payment of $2.4 million.

Stanford has also guaranteed the city as much as $8.1 million in construction-tax revenue to offset any fiscal impact the expanded hospitals would have on the city's budget.

Mayor Sid Espinosa said called Stanford's proposal a "vision for world-class health care" and said he hopes the project will bring the city and Stanford closer together.

"As we move forward with this project, on behalf of the city, we really look forward to a different era of partnership and collaborations with hospitals and the university as a whole," Espinosa said.