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• <br /> • : :Engineenng and Development 6en.fies <br /> • PO Box 547 Anacbries,WA 98-221 • <br /> • 4 Telephone 360.293 1:920 <br /> ' <br /> ax 380.293-1938 41 <br /> • E-rnail enaineenmalavotanacones bre <br /> • RIGHT-OF-WAY PERMIT FRANCHISE APPLICATION <br /> Submit this application.at leaSt Tim rja vs berofe.the work starts Please complete <br /> bOth sides of this form. • <br /> • <br /> SITE PERMIT <br /> L DC ATI ON: 2-))(3 rk 4 it : foW-2019 000g <br /> FRANCHISE INFORMATION CONTRACTOR IN FCOMATION <br /> Company Name CCVMA.))4, (OOL] S141(-efic Name EA -Bnir , MC' <br /> Mailing Address L to va Aye, NkA) kddress ificiAo Nti) 5.641Si <br /> - <br /> City,State,Zip put.4 utv4 RA oi,g -4,1City <br /> 5rrAMM- <br /> letophonp 14J/c. C3- '65 3 i5 State wpi Zip Gt,.03 <br /> Fax Telephone 496,, Lis-lag • <br /> • Contact Name AN-t\Offil e-1-07CAte3 License Number -Fut 1.13Bre4 6thibl <br /> PROJECT alFORMATION <br /> Work Includes(check all that apply) <br /> 0 Curb Cut D Water 0 Sewer El Storm 0 Gas 0 sidewauc <br /> 0 Street cat 0 PhOne ID Power :T4' able 0 CUtverl ED Outside the Traveled Way • <br /> Describe Work A AA IL/ - ' de All - • <br /> ki0 0 'VW a308 xAuk 750re 106c4 <br /> ef065 Aj 11,t) \l" <br /> PEn.M11: TYPE • <br /> 0 Curb Cut$50 0 Street Cut$50 U Inside Traveled Way$50 El 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 end Mbar must use warning Signs,traffic control;andbarricades as <br /> necessary to ensure public safety in the Wilk area. The applident andOwner must restore the right:ref- <br /> tivey to previorOcOnclition. The epplicantand owner are liabialor damage to public arid p t. property: <br /> • I/2-V 11/2Ctifig <br /> ty Appll lion Approval Signature Date Applicant Signe ure Date <br /> Final Kopection Aprbva Sige bate <br />