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g3 <br /> '+ • Engtneenng ON Development SetvtGes • <br /> PO r3ux 5417 Anacort0,WA 95221 , <br /> Talaplions 3 0,2031920 <br /> Or Z gax 360,2,831938 <br /> '6• Erna engineengt.n cilvafan0cenes PM <br /> RIGHT-OF.WA'Y PERMIT FRANCHISE APPL(C.ATIGN <br /> submit this•appiloation 41'1eas,t flvg de vs before the .Wci•k starts Piease oompietp <br /> bath dies of this form. <br /> SITE PERMIT <br /> LOCATION; 266F ' 1, f Gs4 NUMl MR: IC_f)W_LO1dl o 0°Z7 <br /> PRANPHISE IN5'ORMATLON - V GO_NTRAG 'O,R lN'FORMAMION <br /> .dornPanW Name (.rz5e .,e Octit-t u t 6c1 S Name ' t 1}c lie/k ' <br /> • Mailing Address No S >rncl .1-. Address Ley'6'1J6 Tim vriv( ' <br /> city,.$tetp,zip a.).p veozDA - 95 +73 'PLY �i1.k1 - - <br /> Telephone (,(a o)33I0—(O i SIa , . State 4j,4 Zip .. e_d33 -_ <br /> Fax Vii3k0.- Zs(oy Teleph4tte (yzs) qy =31�gy Contact Nerne CAMP- License Number <br /> PROJECT INPORMA7101t <br /> Work triclrxies Mack all that apply) <br /> 0 Curb Out 0 Water 0 aawar ❑Storm XGas ❑'Sidewalk <br /> 0 Street Cut ❑Phone El Power 0-Gable , 0 Culvert 0 Outside The Traveled Web, . <br /> • Describe Work: �t// /4E't,- As - ,Taal Gt' 4' se,--o�2 I Me _i <br /> "J 4. e r� G SX. e. %/1 "-ass ' • <br /> Gt S D i yl G' g Jo -f- <br /> r(... e_., ,pY-le fe fir- �,.-z�,'�% es. . <br /> • <br /> PERMIT TYPE <br /> tJ Curb Cut 05p 0 Street Cut Sao 9 Inside Tradeied Way.Way St50 9 Outside Travafad Way.$20 <br /> SPECIAL F E 4U I R E M EI1TS: l all 1.890.40. 55).5 two bushoss days before yiDu dig. <br /> . <br /> Work within the City Right-of-Way is permlfted by approval of the City Engineer.. All Worn Its the.tight4 . <br /> way must be bonded The npplkcant and ownermust•use warning signs, traffic awl and barricades as <br /> necessary to ensure public safety hike work area. The applldant andowzmir'must restore.Ihe right-* <br /> way to previous adndlkah. The eppflaant;and nwnerare flable`fordemaga to pubffc•a'ttd PMrate prOpetty. <br /> c I. i <br /> Applicatl Apprael Signeture Datt? Applicant -I'Di e— Date <br />