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�'�m.i . Fees L�'_3.t........ .^}."... .. <br /> Engineering and Development Services <br /> PO Box 547,Anacortes,WA 98221 <br /> f Telephone 360.293.1920 <br /> Fax 360.293.1938 <br /> ': *7' ti'J l ! 4#4", E-mail engineerinqcityofanacortes.orq <br /> RIGHT-OF-WAY PERMIT APPLICATION <br /> Submit this application with payment at least five days before the work s:rats. Please <br /> complete both sides of this form. (City completes shaded sections.) <br /> SITE lPiA �' `LOCATION: JZ1 y/'Ll 5 j :. f .V�.tC `O 4 tit, <br /> OWNER INFORMATION CONTRACTOR INFORMATION <br /> Name y9r-�?- • Joi-tdvs4,� Name <br /> Address 4 Cj ' —Z y f� Address <br /> 5, , <br /> City ,2 rb 3 w, 9YZZ/ City <br /> State Zip i 2'L j State Zip <br /> Telephone 61` 20 Telephone <br /> 71 <br /> • <br /> License Number <br /> PROJECT INFORMATION <br /> Work includes (check all that apply) <br /> Curb Cut ❑ Water ❑ Sewer •❑ Storm ❑ Gas 0 Sidewalk <br /> Street Cut ❑ Phone ❑ Power ❑ Cable ❑ Culvert <br /> Describe Work: �c 17 t7 a =�,`✓ �G �- �2 ✓— ;�_ <br /> P '`2rt4 i/ ; &V J- f <br /> TYPE <br /> .# �"eas''�'����r"''�' - � ��� �p���" �� $`°� ,.��.��4�-a y'"u.��a~s� i',x rs�� � r•. S * -- _ ,yam <br /> Lit <br /> 4 k �t �i- €�. .cam d[" �b.- +, 1 `�` cC-L.,RT'�k . �kJ .. <br /> Vag r <br /> - e - _ <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 /> � � � E ti� Applicant Signature Date <br />