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.l , i,i.Iif L•;4-j• i�f�#•L �tt f LLe/•y j fy i�l�i. 102 <br /> F• t F�of E l �i'�- i9 $5 -O <br /> i ii6E f•J_JJ- -v•Jj.R.••e <br /> 'SIX Engineering and Development Services <br /> :' <br /> * r PO Box 54T leph ortes,WA 98221 <br /> Telephone 360.293.1920 <br /> Fax 360.293.1938 <br /> : t • E-mail engineering(a citvofanacortes.orq <br /> 1000, <br /> RIGHT-OF-WAY PERMIT APPLICATION <br /> Submit this application with payment at least five days before the work starts. Please <br /> complete both sides of this form. (City completes shaded sections.) <br /> SITEPERMIT ; ".; <br /> LOCATION: �j�1`►ll,t N"U:1ilroot< � , stityr,, 7014* <br /> 7 <br /> OWNER INFORMATION V CONTRACTOR INFORMATION <br /> 4 1 � <br /> Name ,/A , Name <br /> Address -7 o-7 \,�,, y_alms;.,,,- t:e3 I v`;�. Address <br /> City 1i' „ , k J City <br /> State i Zip c) -Z2 I State Zip <br /> Telephone G o 770 v 3�3 Telephone <br /> License Number <br /> PROJECT INFORMATION <br /> Work Includes (check all that apply) <br /> Era <br /> urb Cut CI water ❑ Sewer ❑ Storm ❑ Gas [�Sidewalk <br /> CI Street Cut ❑ Phone ❑ Power ❑ Cable [' Culvert <br /> P I •Describe Work: .0 t' d;i� cr �� J i�vc ?�( Si' i ..r c l c;`,v:. l�C <br /> d. <br /> re Li.�-•.csSi-e G1 Z.- C L u ✓ l/l .L.� i) ✓.r� Prv� �' ,-,; .„. <br /> 7 p , <br /> ��tx �.i�l/t��///f✓- �{.n^. 'C......cji t/ j�1�12/x/1�.1�, �l�i"i� `r//'Lr_ !d�(/� � � C��- <br /> /ca, a. -r cl au c/. Z_ =�c� c�L'�% 0�4 , <br /> PA'kMIT. TYKE <br /> C ttYki Gut: t C1.t`t$ a 41 id 1 -r ve al.W t k tstde Trpi€ted Way$20 <br /> Y max"G � 'ra a�E-Y' M'. C 4 � 1 j d -- <br /> .k-`i:Tt C#t '�1 I0-iE=IbtT r3-z _f z z �, g t © ►tra:dad before oi. ddlc <br /> ... ':- <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 /> ''...'' '''.."4"t".t. - :ftz'''7:4r4r,„,.- ,.: 404„,......,,,,„ , ,s__, './.2/6-c___,/----- <br /> " �� � � Applicant Signature Date <br />