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ROW PERMIT NO.: ENG(9joQ
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
100010458 Everett Cline pot
PROJECT NAME: holing for ENG20160404 CONTACT: Jayson Gregory/Josh Ervin
CONTRACTOR: Boring Technology Inc
Mailing Address: 12711 198TH St SE Snohomish
State License #: BORINTI852DS
City Business License #:
Phone #: 253-682-9223/425-308-7280
Fax #:
Email #: jagregory/jervin@wavebroadband.com
X Liability Insurance X Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 216th St SW and 72nd Ave W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑ Single Family ❑ Other
X EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes X No
ANY ASSOCIATED PERMITS? BLD# ENG# 20160404
DESCRIPTION OF PROPOSED WORK (Be Specific) :
Pot Hole at (5) locations. See plans for details.
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES X NO ❑ Year:
PAVEMENT CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x