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OV E VA,t0 <br />PROJECT NAME: 106322787 <br />CONTRACTOR: PSE/Infrasource <br />Mailing Address: 1660 Park Lane, Burlington, WA 98233 <br />State License #: INFRASL871 C2 <br />City Business License #: N R-023614 <br />CONTACT: Sue Sidick <br />Phone #: 425-457-6353 <br />Fax #: <br />Email #: <br />❑ Liability Insurance ❑ Bonded <br />ADDRESS OR INTERSECTION OF CONSTRUCTION: 24014 79 PL W <br />ROW WORD ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT: � <br />❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only) <br />❑ Multi -Family ® Single Family ❑ Other <br />❑ EUC (PUD, VERIZON, PSE, <br />COMCAST, OVWSD): <br />Is this permit part of a blanket permit? ❑ Yes W No <br />ANY ASSOCIATED PERMITS? BLD# ENG# <br />DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 163' S C/1 of 240th ST SW <br />and 15' E & 7' W C/I of 79th PL W to install gas service 1 3x5 concrete cut anticipated and 1 2x4 paving cut anticipated. <br />WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year: 106 <br />PAVEMENT CUT: ® Yes ❑ No If yes, indicate size of cut: 2 x 4 <br />CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: 3 x 5 <br />