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C.1 �-- d� Engineering and Development Services <br /> 3 `. PO Box 547,Anacortes,WA 98221 <br /> Telephone 360.293.1920 <br /> Fax 360.293.1938 <br /> E-mail engineerinci cityofanacortes.orq <br /> 10016 <br /> RIGHT-OF-WAY PERMIT FRANCHISE APPLICATION <br /> Submit this application at least five days before the work starts. Please complete <br /> both sides of this form. (City completes shaded sections.) <br /> SITE PERMIT r� <br /> LOCATION: 13208thST NUMBER: ROW—20i9w- OOl <br /> FRANCHISE INFORMATION CONTRACTOR INFORMATION <br /> Company Name PSE/Potelco Name Potelco <br /> Mailing Address 1660 Park Lane Address 1660 Park Lane <br /> City, State, Zip Burlington Wa 98233 City Burlington <br /> Telephone 425-457-6353 State WA Zip 98233 <br /> Fax 360-766-5504 Telephone 425-457-6353 <br /> Contact Name Susan Sidick License Number POTELI#34404 <br /> PROJECT INFORMATION <br /> Work Includes (check all that apply) <br /> ❑ Curb Cut ❑Water ❑ Sewer ❑ Storm ❑ Gas ❑ Sidewalk <br /> ❑ Street Cut ❑ Phone Power ❑ Cable ❑ Culvert ❑ Outside the Traveled Way <br /> Describe Work: PSE to close shoulder to remove 1 span of OH wire between P01 Grid# <br /> 455814-156796 &P02 Grid#455814-156781 pse to close shoulder for <br /> transfomer installation under job# 101117784 <br /> PERMIT TYPE <br /> ❑ Curb Cut$50 ❑ Street Cut$50 ❑ Inside Traveled Way$50 ❑ Outside Traveled Way$20 <br /> SPECIAL REQUIREMENTS: Call 1.800.424.5555 two business days before you dig. <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 /> liz`1��9 Susan Sidick 01/24/2019 <br /> ty Applicat n Approval Signature Date Applicant Signature Date <br /> Final Inspection Approval Signature Date <br />