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• <br /> • <br /> • 'Engineenng ana Develogrrini services <br /> PO Box 547 Anacortes, WA 1132.21 . <br /> • Telephone 360.293 1920 <br /> pax 360.203 19.38 <br /> 't'l'Obtte; • • enaineennqacitvotanacortes bra <br /> ROG:HT-SF-WAY PERMIT F-RALICHIS APPLICATISN <br /> Submit this apphOation a east clays before-The work starts Please complaie <br /> bOth sidet of this form. <br /> • • • • <br /> WIVE PERIVIOT <br /> L©CATION: DOCI4- 61(Gthii PL NUMBER: gow--zei -- 000 7.- <br /> F r,A N C 1-1 IS e 110ORMAINION CONTRACTOR INFORMATION. <br /> Company Name avoao-1,-cod shacko- Name lytk.-Buf-e <br /> Mailing Address <br /> (0 va‘).c, PpR NW Address \iff*(ow 6 <br /> • City,State,Zlp &ucwp qg•31 City 5ert-F4k <br /> 'Telephone L-Ign-5?1° 15 . State _WO Zip Q 03(e, <br /> Pak . Telephone -LID 9 • <br /> • C°ntPPt M a y-0,e,1 tej License Number TuLLBt <br /> PROJECT INFORMATION <br /> Work Includes(check all that apply) <br /> El Curb Cut 0 Water 0 Sewer 0 Storm El Gas 0 Sidewalk <br /> o Street Cut 0 phci.ne 0 Power • citable D CUivert El Outside Vie Traveled.Way <br /> D:esoribe Work: , -41/, T-FD C CA4COA CNN ")01-:( <br /> 1 " 0 • <br /> -417" s v05$iin 9 DIA) . g30. <br /> • <br /> • <br /> PIER4Vilt TYPE <br /> 0 Curb Cut$50 0 Street Cut$50 Ej Inside Traveled Way$50 U Outside Traveled Way.$20 <br /> SpEeIAL REQUIREMENTS! Cal/9.800.424.5555 two business days!Wore you dig. <br /> . . <br /> Work within the City Right-;of-Way is permitted by*prove!of the City Engineer. All work in the-right-of- <br /> way must be bonded. The applicant and owner must use warning atm traftIp control;and barricades as <br /> necessary:to ensure public safety.in the vvtittalrea. The sppliOsnt'snclewnertnust restore the rijht;of- <br /> wey to preViouSocindifion. The opplipantiand owner are IlableYor damage to Tblio and pdvatsprpperty: <br /> • <br /> )2O11(- <br /> ity Ap I n Approval Signature Da e Applicant Signature bate <br /> . • <br /> .FI:nal tripection fpprOva 8igture bate <br />