Laserfiche WebLink
0609004 <br /> M;rN_ic:-_ 0001 <br /> _ , ``.°ut!_` ._ ,... 102 <br /> --30; 00 <br /> : , Engineering and Development Services <br /> PO Box 547,Anacortes,WA 98221 <br /> '" Telephone 360.293.1920 <br /> Fax 360.293.1938 <br /> '''�:... "''' ` E-mail engineering(a�citYofanacortes.org <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 C�, J -jsf P RMill . ^�� ,� ~� <br /> LOCATION: !f l® I � ! N,t UK£ 'ER: �CUl1U-C oo - 7 D <br /> OWNER INFORMATION/ CONTRACTOR INFORMATION <br /> Name U -1e/1 r0 l''` Name GI?,�1i�.1 f;--y�-. <br /> Address ✓/`9/9 al./ To sr— Address <br /> City Ar,Jr-G=L!i4 5 City <br /> State / ,, Zip F ( State Zip <br /> Telephone i7 ramr�2 -` <br /> ;`. 7 Telephone <br /> License Number <br /> PROJECT INFORMATION <br /> Wor Includes (check all that apply) <br /> Curb Cut ❑ Water ❑ Sewer ❑ Storm ❑ Gas ❑ Sidewalk <br /> ❑ Street Cut ❑ Phone ❑ Power ❑ Cable ❑ Culvert <br /> Describe Work: � 0,ig r-)/'Lc1C=-ice [r 577A-. :i%7 I I/ — du I V7&?(-) <br /> "3x ,1 i'r'RO/ 3 f=i <br /> 9- 2 ( q 7 2- .v,,Y - <br /> p—git my!.. TYPE <br /> Curb:Cut$5a 0:Street Cut,$50 ,C,I Irtssde Treveled'Way$50 ' ❑,Outside.Traveled Way$20 <br /> S C'I AL R E AU tt E.M E INFT S Galt 1:8O` 424 5555 two business days before you:dig - <br /> f Re <br /> c cam: u_1 iA-E rr '. <br /> - ,-: p'.' ': , - . V3. -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 /> '-fi ' . ' .- - - _.:1_,/_ _ <br /> I i : ' maiion,approvat Signature Date: •p• cant' Signature D e <br />