EDMONDS ROW APP JT 234144.pdfROW PERMIT NO.: ENG
ISSUE DATE:
4C.-I-Soo
PROJECT NAME:C,6w,(,(j \(_�(A CONTACT:
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CONTRACTOR: wMr Phone H:
Mailing Address:,
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-State —License
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City Business License #.-
ADDRESS OR INTERSECTION OF CONSTRUCTION:
4:
Email #:
Liability Insurance Bonded
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
U Commercial F-1 Subdivision El City Project El Traffic Control (Only)
Ll Multi -Family Sdo Single Family F1 Other
L] EUC (IUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? F] Yes El No
ANY ASSOCIATED - PE.RMIT:S:?] BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific):!
C�WLX�, Voo CkAA ffk, xNe�a k �Y'44 mmy
'VAS STREET OVERLAYED 'WITHIN TFiE LAST' F`IV��. YEARS? YES ❑ NO � 'Year:
PAVEMENT CUT: 0 Yes [Zf No If yes, indicate size of cut: x
CONCRETE CUT: El Yes ZNo If yes, indicate size of cut: x
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