ROW Application.pdfI "r I S90
PROJECT NAME:
CONTRACTOR:
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ROW PERMIT NO.: ENG 1Jl �W _
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
ION
PERMIT IT APPLICATION
49-11o'_2 CONTACT:
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Phone#:
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Mailing Address:�Fax #:
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State License #:mail #:
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City Business License #: Liability Insurance [f Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: Z,q 1101 �7 r rl 115iG 44611(_1
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial aITSubdivision El City Project Traffic Control (Only)
Fj Multi -Family Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes ❑ No
ANY ASSOCIATED PERMITS? L BLD#
DESCRIPTION OF PROPOSED WORK (Be Specific) : (r✓���
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ENG#
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WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES ❑ NO ❑ Year:
PAVEMENT CUT: ❑ Yes ❑ No If yes, indicate size of cut:
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut:
x
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