Laserfiche WebLink
052870• -2 }r j 0 +i i 1rr C 3 <br /> _,...a..r+v v'-�r i i_i�.�i�. iv,•`1'i,;,•:�v_ii_i,.3 002 u <br /> t•t { ii , r+_,_ •t lt-. 5 t <br /> �.l v�vi•. •�� -f.d.�a i" v i'iil•_,i C•:�.�•rrlirri t.=- �•Ji�,ili_,. <br /> ar Engineering and Development Services <br /> F <br /> :: ` PO Box 547,Anacortes,WA 98221 <br /> ' Telephone 360.293.1920 <br /> Fax 360.293.1938 <br /> *` ,. 1.v°, E-mailc�ail engineerinqc tvofana ortes orrg <br /> RIGHT-OF-WAY PERMIT APPLICATION <br /> Submit this application with payment at least five days before the work starts. Please <br /> complete both sides of this form. (City completes shaded sections.) <br /> SITE - ,> _$ -:vg<="' <br /> 1 k 041 -.0 <br /> LOCATION: 311 jet°( 'E 1 e .. ., <br /> OWNER INFORMATION CONTRACTOR INFORMATION <br /> Name hod " )MoC.,K Name <br /> Address 13C l I-7 Address <br /> City 4schAtioiltys City <br /> State L)tr Zip i State Zip <br /> Telephone r *+ .15 tfi Telephone <br /> License Number <br /> PROJECT INFORMATION <br /> Work Includes (check all that apply) <br /> X Curb Cut ❑Water ❑ Sewer ❑ Storm ❑ Gas ❑ Sidewalk <br /> ❑ Street Cut ❑ Phone ❑ Power ❑ Cable ❑ Culvert <br /> Describe Work: 0\16�,. e '13 Lj 'S\4 v`) �JL. Pik,\V (� <br /> 2 <br /> • <br /> Y <br /> ' <br /> •Y <br /> t} tF . . r5„ ! Fw . 0 <br /> - <br /> L 3 ha d:ug1 i- <br /> � i v . .1:�' i.�"hUY�` �, . t?�,: i, . , , <br /> ",,,'''-'404-ntigat,---7-ApitoWitillt,' Vitapkittp4,..„4, 9611.0.LL';_„40W-4,,.:::.71? ,,,,',3; :, ,oikk_zyt,,,, ;:;i1-6 . ,,„i <br /> 4 <br /> .,,,4,;,..5.,>.‘,4:.-tw,,, <br /> ySigp <br /> d ai�,6 : Mr Ewa, q '§''S T`- 3' tic .:Mi. ,,, ;:;,: <br /> -k b -'� <br /> ��� A .� �-a4.�- „�t „�•t ki z Car 6a' {+�� �. . �,:," c'�='_ �`Ea �.` �.� <br /> 6 �:..A.S:AY•-x,,,a., '`^t>:, h�. s�'<,y 'n,...-qz=S+„;•� u:m va-„-m <br /> .«,at,�t,:..,�{.--a�-��-�� t �4 {> Y,�;-.�=E�o.'...�E wrE�a�.. `+r.,� .'�„.',a„".0,-�.c 3s`� ,iT. �:: <br /> ,: . ; .,fir' i:S :v,,; r y,„ '; 'iir�'= # .'a' .aa-�> <br /> Work within the City Right-of-Way is permitted by approval of the City Engineer. All work in the right-of- <br /> way must be bonded. The applicant and owner must use warning signs, traffic control, and barricades as <br /> necessary to ensure public safety in the work area. The applicant and owner must restore the right-of- <br /> way to previous condition. The applicant and owner are liable for damage to public and private property. <br /> a <br /> f <br /> 4.4 ::' v;tll,2',4a.M;,,N,:A:,t:-prtM;;;;z:,'wiz.,:9:m:kz'kz. 4,:,?,aztall* :41;`.tse::',44'W 9 j J5/05 <br /> -Reswt'r .,w <br /> Applicant Signature Date <br />