HomeMy WebLinkAboutPermit File 1911 6th Street P..i:ii i t Fees_.... 005923 $50 00
'404100w, j Engineering and Development Services
PO Box 547,Anacortes,WA 98221
Telephone 360.293.1920
COFax 360.293.1938
'4 E-mail engineering(a,cityofanacortes.orq
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RIGHT-OF-WAY PERMIT APPLICATION
Submit this application with payment at least five days before the work starts. Please
complete both sides of this form. (City completes shaded sections.)
SITE PERMIT
LOCATION: ice ` $54fe se'- k)t' NUMBER: (,0 Q(. a- l �
OWNER INFORMATION CONTRACTOR INFORMATION
Name At W kQj1 Name ,\ vAQ_ i';t(m
Address c fl Address 49 9_ -.off C ,-3(
City 4A &I- City
State Zip , ®A State Zip 9€
Telephone , , o.) -- Telephone (. ,' 9-2, .—q{0
License Number j1O C>I O L H
PROJECT INFORMATION
Work Includes(check all that apply)
El Curb Cut El Water El Sewer El Storm ❑ Gas El Sidewalk
Street Cut ❑ Phone ❑ Power El Cable El Culvert
Describe Work: (14P_,0-k- C 1M2. k\ c 1\)()l( 06 kI'-I (1 6k_ l.)I
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PERMIT TYPE
El Curb Cut$50 IS Street Cut$50 ❑ Inside Traveled Way$50 El Outside Traveled Way$20
SPECIAL REQUIREMENTS: Call 1.800.424.5555 two business days before you dig.
Work within the City Right-of-Way is permitted by approval of the City Engineer. All work in the right-of-
way must be bonded. The applicant and owner must use warning signs, traffic control, and barricades as
necessary to ensure public safety in the work area. The applicant and owner must restore the right-of-
way to previous condition. The applicant and owner are liable for damage to public and private property.
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City Application Approval Signa ure Date Applicant Signature Date
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