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ROWPERMITNO.:ENS
ff ISSUE DATE.
RIGHT-OF-WAY CONSTRUCTION gy COP
PERMIT APPLICAnON C!
PROJECT NAME: Panera Cafe 9,11515 CONTACT, Eric Morff, RE
CONTRACTOR: TBD
Mailing Address: TBD
State License #- TBD
City Business License #: TBD
Phone N' (314) 843-4320,
:9. (314) 843-4323
Emafl#: emorff@c:ore-eng.com
El Liability Insurance [:1 Bonded
AIDDRE SS OR INTERSECTION OF CONSTRUCTION- 792-9 Lake Ballinger Way
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ETEC (PUD, VE, RIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? Yes No
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ANY ASSOCIATED PERMITS ? ENG#
DESCIUPTION OF PROPOSED WORK (Be Specific). Reconstruction of driveway a*#,
sidewalk at entrance to meet ADA requirements.
I
PAVI EMENT CUT- F/-1 Yes 0 No If Yes, indicate size o , cut: 6.5'
CONCRE TE CUT: Z Yes �D No Hyes, indicate size of'cut-
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 be
patched with asphalt or City approved material prior to the end of the workday — NO EXCEPTIONS.
I have read the above statep, tints and npderstand the: permit requirements and acknowledge that I must
follow all requirements 01(order,for e permit to be valid.
SIGNATURE DATE
tractor or Agent