HomeMy WebLinkAboutROW-2004-0365 - SIDE SEWER REPAIR OR REPLACEMENT H &3
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Engineering and Development Services
PO Box 547,Anacortes,WA 98221
Telephone 360.293.1920
Fax 360.293.1938
E-mail engineering(-a)_cityofanacortes.org
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.)
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SITE
OWNER INFORMATION CONTRACTOR INFORMATION
Name i�� Name
Address �.Y (�. ( C Address
City �4>._ City
State Zip ���' Z Z. State L`,.._� . Zip
Telephone 3 F 5- --� Telephone
License Number
PROJECT INFORMATION
Work Includes (check all that apply)
❑ Curb Cut ❑Water INSewer ❑ Storm ❑ Gas ❑ Sidewalk
❑ Street Cut ❑ Phone Power ❑ Cable ❑ Culvert
Describe Work: ��
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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.
Applicant Signature Date
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SITE DRAWING
1 . Show north arrow
2. Label streets
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3. Draw plan
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