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HomeMy WebLinkAboutPermit File 3311 V Place Engineering and Development Services �' PO Box 547,Anacortes,WA 98221 Telephone 360.293.1920 ' �: Fax 360.293.1938 is" E-mailneerin ci n ortes.or' •..; � enq q(c� tvofa ac q -•V 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.) LOCATION: 33ii l! /u�L ;I+f 1 V,' V C J OWNER INFORMATION CONTRACTOR INFORMATION Name r �� 17( L LL / Name �L- (p? aL U Address f Li f Gc-`jil l/ L,-ev, ( Address 1 (a L �a0 t "c vn ( v-Q._ City 1_p a�ak.Lt1ti (- City u Lim e ,`j ('v ;� f6,State I , Zip c2L, L ) State C i (A t! Zip Telephone 3 cd) C 2 e9 - 0 ( 3- Telephone '2 b 0 ..- 7 C 5-2_ License Number PROJECT INFORMATION Work Includes (check all that apply) ❑ Curb Cut ❑ Water ❑ Sewer ❑ Storm ❑ Gas ❑ Sidewalk ❑ Street Cut ❑ Phone KPower ❑ Cable ❑ Culvert D scribe Work: 'e (�2 L'Lc:. v' 1�,51/J Lit2 (��`,t) i.- PC) .�c.,.�- -- _,a , c PERMIT TYPg -Curb Cut$50 ,❑ Street C t$ ? Ins'id Traveled-1lWay$5Q: 0 Ou •ide Traveled=Way$20 S '.,I C I A L RE 4U It R E M E t T - € sCa ii i 8OO 424 555 #wo bqsrf ess days before you.did T fi (- 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. ` Ak :: n `P cg per@ fi l(*itin l rOWS10 e xw me Applicant Signature Date SITE DRAWING 1 . Show north arrow 2. Libel streets 3. Draw plan • CONSTRUCTION ;INSPECTED AND APPROVE© :-.5�. �.;�'v .,fir ,� �, €S� -•`?n ,£�- ;,.`:i. I7�.•s t .