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• <br /> • <br /> (rngioeering zlncl Gevelaprrient SBIVMCe <br /> •• <br /> R0 Box 547 Ar)acories,WA 9822i <br /> T ilephone a60,2931920 <br /> f:ax 36U•293 i 938 <br /> . Email engtneenngt@rcilypfanacartes aro <br /> • RIGHT-OF-WAY PERMIT FRANCHISE APPLICATION <br /> Sub.rnit this application a.11east flvo days before the wwgt1 starts Please complale <br /> both sides Of this form. <br /> SITE PERMIT <br /> LOCATION: �8.649 Q AVE NUMBER,. govj- <br /> PtANcH1SE INFORMATION COATRA'cTb.lR INFORMATION <br /> dompany IJam'e C. .S a2. Na4..-r4� GAS Name rC .4.5C llkah_vu/Gas • <br /> • Mailing Address 157,0 5 LND sr Address N1�57.0 5 2 N� sr <br /> •State,Zip MDL4v4T M Veoi vV/r 6Z7,3 C 1t o14t 1 1' <br /> Telephone 6 Ivo)3310- (al State KlA._ Zip 9SZ 73 <br /> Fax (36o) 33(0-2-577L/ Telephone, Go)33to—( 15-G <br /> Contact Name G Lloense Number <br /> PROJECT INFORMATION <br /> Worts Includes(check all that apply) <br /> []Curb Cut ❑Water 0 newer D Storm t Gas ❑'Side*aili <br /> (l Street Cut E Phone 12 Power D.Cable . []Culvert 0 Outside'the Traveled Way <br /> Describe Work: �s'S<S rta-ee I, e tie ss . <br /> w:1 �./,19cox• .- <br /> S t i��e r� r�s s -s1 , Late - <br /> Ir> e-<S ryC,s wutt4 v . . <br /> • <br /> • <br /> • <br /> PERMIT TYPE <br /> ®Curb Cut$50 Q Street Cut$50 0 Inside Travated Way$50 e1 Outside Traveled Way.$20 <br /> SPECIAL REQI IREME.NTS: • Call 1.t3Do.424.a55.Iwo businoss.days before you dig. <br /> • <br /> Work within the City Right-of-Way is permitted by approval of the City Engineer. All Worjc 1r'1 the t-ighkif <br /> way must be bonded. The applicant end ownermust.use warning signs, traffic control,and barricades as <br /> necessary to ensure public safety lathe warts area. The applidant and owner must restore•the right of <br /> way to previous condition. The applicant:and owner are lleble'for damage to public,rind private property. <br /> )ty ppiidatio, Val Signakure - Date 1ntSIgnatur D to <br /> . <br />