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07:20804 <br /> F 0002 <br /> 0 7 00 102 <br /> ...rita1: . _.-_ 007634 .20..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 engineeringacityofanacortes.orq <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 <br /> LOCATION: / z `� C - E 2. 'Tack -O <br /> OWNER I F /ORMATIO CONTRACTOR INFORMATION <br /> Name %`�c't,,,22,4 , C rir Name Ste.-//' <br /> Address 76+ L 4 / /--2 Address <br /> City t .c' C-1-74 City <br /> State r ,4, Zip �-' Z / State Zip <br /> Telephone Z, 26f 25C e2 Telephone <br /> License Number <br /> PROJECT INFORMATION <br /> Work Includes (check all that apply) <br /> [A-Curb Cut ❑ Water ❑ Sewer ❑ Storm ❑ Gas ❑ Sidewalk <br /> ❑ Street Cut ❑ Phone ❑ Power ❑ Cable ❑ Culvert <br /> / r <br /> Describe Work: f>-E`77 '"e et. -eX <br /> ')Gam! e'/7/4' e e (4'" eP1f'eG/-e (.t, 4 , f'-Gr 7,O 4/ <br /> tllI Tip <br /> ❑-fir Cut$ A❑` tr t p4 r=` ` iI `+ >io, O sr '40vei Way)$20:43 ` <br /> �- s i* d ttoM`EN 5: at 40, ,- o usiness gays efore you-dig <br /> s <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 /> f 7- � � <br /> Applicant Signature Date <br />