Laserfiche WebLink
1Y I <br /> Engineering anc Development Services <br /> : PO 5Jx 547 Anacortes,WA 88221 <br /> Telephone 360.2931920 <br /> 4. cax 360.20319.38 <br /> c-mail enameennqOcdvotanaio'tes ore <br /> RIGHT-OF-WAY PERMIT FRANCHISE APPLICATION <br /> Submit this application at least'fi.va days before the work starts Please complete <br /> both sides a! this form. �? <br /> SITE PERMIT <br /> LOCATI .IN! 14aan PL NUMBER: C1Ihl Zat� C>eq.?(e, <br /> FRANCHISE INFORMATION CONTRACTOR INFORMATION <br /> Company Name Cub ccati ACO ,..ksvIcto/, ,t Name i'� Mc <br /> Mailing Address LW_Vek1V64 KIR NW Address O ff �t�(,0 _ <br /> • City, State,Zip CJI`�(1 W I 611 City '•et4,444,..e" <br /> Telephone 1+ - 5: c�; m 5 't? ( °5 State w Zip C t-cy3(o_ <br /> Fax Telephone <br /> Contact.Name cOctrt\ati,, Gon2cA4e 3 License Number To 1 v1 Welt .'jL1D2 <br /> �'PROJECT INFORMATION <br /> Work Includes(check all that apply) <br /> ❑Curb Cut ❑Water ❑Sewer ❑Storm 0 Gas Sidewalk <br /> p street Cdt Q Phene 0 Power a6abl.e D Culvert 0 Outside the Traveled Way <br /> Describe Work: ok--1-i n 'F 'i► . ?EP ii • ‘11 bort Co(oc- <br /> N evo5 i In.i .t-) Q►xrA Pi v 44..1 v 23 <br /> • <br /> PERMIT TYPE <br /> ❑Curb Cut$50 0 Street Cut$50 0 Inside Traveled Way$50 0 Outside Traveled Way$20 <br /> SPECIAL REQUIREMENTS: Cell 1.800.424.5555 Iwo business claim before you dig. <br /> • <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 I; <br /> necessary to ensure public safety in the work area. The applicant end owner must restore the right-of- <br /> way to previous cdndition. The applicant.and owner are liable for arnage to public a. private property. <br /> . 1/ 7/ici ///2q it <br /> ity Appli lion Approval Signature Date Applicant.S1 tore Date <br /> Final inspection Approval Signature Date <br />