Laserfiche WebLink
Engineering and Development Services <br /> STY Q PO Box 547,Anacortes,WA 98221 <br /> Telephone 360.293.1920 <br /> Fax 360.293.1938 <br /> E-mail engineering( <br /> 0,316 RIGHT-OF-WAY PERMIT FRANCHISE <br /> APPLICATION <br /> Submit this application with payment at least five days before the work <br /> starts. Please complete both sides of this form. (City completes shaded <br /> sections.) <br /> SITE PERMIT <br /> LOCATION: 14107 KINGSWAY NUMBER: 1(-0* — Z.019 — 60 I <br /> OWNER INFORMATION CONTRACTOR INFORMATION <br /> Name Comcast Name Pacific Cable Construction <br /> Address 410 Valley AVE NW#9 Address PO Box 573 <br /> City Puyallup City Woodinville <br /> State WA Zip 98371 State WA Zip 98072 <br /> Telephone 425-263-5315 Telephone 425-353-2078 <br /> License Number PACIFCC954PJ <br /> PROJECT INFORMATION <br /> Work Includes (check all that apply) <br /> ❑ Curb Cut ❑Water ❑ Sewer ❑ Storm ❑ Gas El Sidewalk <br /> El *Street Cut El Phone ❑ Power ® Cable ❑ Culvert ❑ *Street Closure <br /> *Must submit Traffic Control Plan Form <br /> Describe Work: INSTALL CATV SERVICE LINE. <br /> BORE A TOTAL OF 81 FT IN THE ROW. 60FT SOFT SURFACE, 21 FT HARD SURFACE CROSSING <br /> DRIVEWAY OF 4103 <br /> PERMIT TYPE <br /> ❑ Curb Cut$50 ❑ Street Cut$50 ❑ 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 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 /> 1//2- J)7 1-11-2019 <br /> Cit pplication pproval Signature Date Applicant Signatu Date <br />