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CS Engineering Engineering and Development Services <br /> PO Box 547,Anacortes,WA 98221 <br /> (;a0),;,a Telephone 360.293.1920 <br /> Fax 360.293.1938 <br /> eq (c�E-mail engineeringcityofanacortes.orq <br /> eon <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 1 i. aPERMIT �] <br /> LOCATION: 7(9E4S-14 2L' 1 1 C�Sa�`�c. Say NUMBER: V-bVJ -"LC19 <br /> FRANCHISE INFORMATION CONTRACTOR INFORMATION <br /> Company Name C..cyvteo,sk. Name Cp,b\er Cm l,[-.C. <br /> Mailing Address 170 �yy v t 13) Address 10l7 O r� <br /> City,State,Zip `1,ikce ntc� lV 3- l c 163 City \��vA6ka-rl. - <br /> Telephone S(40- 316- 9 Or State t,VA Zip Q'3 4 <br /> Fax Telephone 3 d- 11- 2 cqg <br /> Contact Name Sv\cxyva,_ License Number CA2 L.EL 171 pp <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: Rr-e o Wro7C. 1 j3 O�rQss S F i NQ�o 130o.1 RA *lei-. <br /> +Y-ev\ct., o-wro)( z27 ' c-lat S r Fidalgo y kr, nek <br /> t]4 They, <br /> L'6W>^Qgl t�l-IF• ch ornrj p <br /> S r c-o, y el.J c owtcas\- t10 k.1 - <br /> I o ti3Sptsc- is 'k c t t b . o- rvt r;...0.w-e de }-h OS 3fo +r <br /> lob Pec 30(e2 t17 <br /> PERMIT TYPE <br /> ❑Curb Cut$50 ❑Street Cut$50 J 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 /> )// 11 <br /> ty pplicatio Approval Signature Da a Appl cant Signature Date <br /> Final Inspection Approval Signature Date <br />