APPLICATION-SITE PLAN.pdfM._ GN P- f P'k I i'�
ROW PERMIT NO.: ENG
ISSUE DATE:
RIG[IT-OF-WAY CONSTRUCTION
Mailing Address: k9 ZZ�; 611yw 9it. O e ' D('
State License #: a
City Business License #: - —
Fax #:
Email #
Liability Insurance rBonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: �GI ZZ-� L� ( {�� Vll eul' �lG. GC ti fL' r,G
ROW WORK ..
ASSOCIATED WITH THE FOLLOWING TYPE. OF PROJECT.*
Commercial
❑ Multi -Family
Subdivision
❑ Single Family
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
City Project
❑ Other
❑ Yes A No
Traffic Control (Only)
ANY ASSOCIATED PERMITS
BLD#. ENG# ww
DESCRIPTION OF PROPOSED WORK (Be Specific) �.P�.e
�..m._ ...�.e e.._� __ ....
WAS STREET OVERLAYED WITHIN THE LAST FIVE ( ) YEARS? YES ( NO[,. Year
PAVEMENT CUT:
CONCRETE CUT:
❑ Yes [A No
❑ Yes [X No
If yes, indicate size of
If yes, indicate size of cut:
I RIGHT-O F-WAY DURATION
AREA TOTAL
CLOSURE (NUMBis
ii
ER OF MONTHS)
Sidewalk 48 Hrs +
. . . . . . . . . . . . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - - jjj ............................................ ..............
Alle 7 2 H' r-s
Y
Parking 72 Hrs +
APPLICANT TO READ AND SIGN
*Traffic control and public safety shall be in accordance with City regulations as required by the City
Engineer. Every flagger must be trained as required by (WAC) 296-155-305 and must have certification
verifying completion of the required training in their possession.
*Restoration is to be in accordance with City codes and Standards. All street -cut trench work shall bij
patched with asphalt or City approved material prior to the end of the workday — NO EXCEPTIONS.
any 5 epartments or employees, i7sclualn.4, VeTen
of granting this permit
I have read the above statements and understand the permit requirements and acknowledge that I must
follow all requirements in order for the pen -nit to be valid.
SIGNATURE DATE -_1ZZ01
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