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. . <br /> . . <br /> ....,..." .. <br /> Engineering ana DevelopMent Services <br /> PO 5,.fx 547 Anacartes,WA 98221 • . <br /> • 411111rt6 Telephone 360.293 1.920 <br /> .44 .4 ex 360.293 1938 <br /> E-mail enomeenncOcitvotanacories or <br /> . .:. ' RIG:11T-OF-WAY PERMIT FRANCHISEAPPLICATION <br /> • <br /> Submit this application.at leaSt 21`111121 days before the work starts Please compiote <br /> both sides of this form. <br /> • ' <br /> SITE PE! MIT <br /> LOCATI*N: 6801 N AV€-- NUMBER: R OV201,61 0013— <br /> FRANCHISE INFORMATION CONTRACTOR INFORMATION <br /> Company Name L„,,c0,51--(--,„:43 s000dedi Name "-- pt1 Vywe. INC. <br /> Mailing Address 410 val\ej ?w NI u j Address 19.4(r) Nu3 6b-ci-t 5+. <br /> • City.State,zip ip,t7,11vue, w 6 cib'YrI, City <br /> Telephone (k-6-.5)5G3- 53 . State u„..)6 Zip qb10-1-_ <br /> Fax • Telephone (.9_5) 7-Li D_84 <br /> • Contact Name 16 ci4 t-ewaytez License Number fu Lk...V:461_494 Di- <br /> PROJECT INFORMOION <br /> Work Includes(chock all that apply) <br /> 0 Curb Cut lill Water 0 Sewer D Storm 0 Gas 0 Sidewalk <br /> 0 Street Cut 0 PhOne 0 Power • irl Cable 0 culvert_ 0 Outside the Traveled Way <br /> Despite Work: At .y( fi a 44,6, AL-, - . .a ii• , is iik 16 OIL. . i 0 <br /> ' lx) ib• 'I' aoliniER.4 P c 0 4 .„ _ _. vii( 1 • - <br /> . •• . <br /> , .. <br /> . . . <br /> . • . . <br /> PERMIT TYPE <br /> 0 Curb Cut$50 0 Street Cut$50 U Inside Traveled Way$50 0 Outside Traveled Way,$20 <br /> SPECIAL REQUIREMENTS.: Call/.800.42.4.5556 two business days before you dig. <br /> . . <br /> ' . . <br /> • <br /> . . <br /> Work within the City Right-of-Way is permitted by approval of the City.Engineer. All work in the light-of- .. <br /> way must be bonded. The appilbantand owner must use warping Signs,traffic control,-and barricades as <br /> necessary to ensure public,safety in the wane area. The appliOant and gwner must restore the right,of- <br /> way to preViotWatindiflon. The applisantand owner are liable damage to public and private.property <br /> 1 <br /> . I <br /> ' . . <br /> 1R <br /> ._ __. <br /> -C pplIcatio Approval Signature De li2 Appli n . Ignature Data <br /> • . <br /> • <br /> Final Inspection Approval Signature Date , <br />