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• <br /> • <br /> J A Fn lneenng tincl Development Se1V,oas • <br /> 1?O Bux 547 Af)200tiSt WA 9B221 <br /> Toiaphone 360,2031920 <br /> gax 3611,2931 w <br /> E-mail angmeenngi ily anarman pal <br /> Ri•GHTa9F.WA'y PERMIT FRANCHISE APPLICATION <br /> Sub.n It this .application a.f lees,t fhp days before the •wa.,fk elects Pipe4e complete <br /> both sides of this form. <br /> • <br /> a1TE • <br /> Pf+RMl. <br /> LOCATION: /60 D N11MEIER: p3`v4 2 d 19- 002L1 <br /> PRAtIcHISE INFORMATION CQ_N T RA•CTIQ,R 4/FORMATION <br /> .dompany Nam CaS mile. tia-f - t (064 fume M16I eds_ <br /> Mailing Address 1 '2U S 2_wtd Sf. Address „62,7 $�L6NAV fl/( <br /> City,Mate,Zip bait Venw✓t tic- 9 �1 •City _ YAK/. e <br /> i�iepfaane C(oo)33to'(viS(r, , state it/t Zip /6033_ <br /> • <br /> Fax tata0 ��' zs &- eiepl�otte, cyZS) 1 y 730 gy <br /> Coiitact Name (' deSION Lleense Number <br /> PROJECT INFORMATION <br /> Worlc lhaltrdes(cher*all that apply) <br /> [Q Colar Cut Water []Sewer 0'Storm ►..1 Gas jaSideWal}c <br /> U Street Cuf 0 Phone 1 Power D Cabie , 0 Culvert D Outside The Traveled Way <br /> • Describe Werk; . /15 / As 2- /the • <br /> /{//// 4. ar X tsxc' - // Ade /1 `, r- i / a•//� <br /> eless( iyl� ,"�j. /t' % ,/ oi-- e 7� "' •.t�ch�,/.7»-S .• - <br /> PERMIT TYPE <br /> 111 Curb Cut 5tl 0 Streat Cut$5© 0 inalde Traveled Way• a 0 Outside Traveled WE4y.$23 <br /> SPECIAL tEgtfl MM Ell Sfstr Fall 1.aL1o.40.tua1 two ba$1tVas.daysbefore you dig: <br /> • <br /> Work within the City ROM-of-Way is pprmffted by approval of the City Engineer. All Word Its the 11213t.6t <br /> way must be banded. The eppllaant and awnermust•use Mining signs,tratfi'a aantrnl,and barrlaad s as <br /> necogsary to ensure puhlla safety ln•the work area. The applldant end awral rmustrvstara the r/ght-.f- <br /> way to previous atindit/ori, The appliaaat;and owner are[fable'for damage to public•ahriprivate prpperty, <br /> ,It Appff pnApproVelSigneture L7ata Applicant Signature Date <br />