2015-01 ROW Permit 02032015 City of Yelm . _.'mit No. 2015-01
PUBLIC WORKS
901 Rhoton Rd NW Application to Perform Work on
Yelm,WA 98597 Public Right of Way and/or Connect
Phone: 360-458-8406 to Utilities
WAINK VON FAX: 360-458-8417
APPLICATION _
The undersigned hereby makes application to: B0RE FROIVI EXISTING POLE ACROSS CREEK ST SE 50"
HEADING WEST PLACING 1-4" CONDUIT @36". PLACE NEW COMCAST PED THEN TRENCH IN ROW 100'
TO PRIVATE PLACING�1..-..2.." CONDUIT @ 36"
..........
......... .............._.....e.... -..
JT#138705 a
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Location of work: 305 CREEK ST SE YELM WA 98597
I agree to perform the work in strict compliance with Yelm Municipal Code,� - ������d i....._� rnerat
Municipal Code, the special conditions i�nw����r�em°ated�
herein and the attached conditions I have read and will adhere to the general provisions applicable to permits
contained on this form.
............n .... ..... .........m ....
The Public Works Department(360-458-8406) must be
contacted for inspecton 24 hours b efore work
....commences gE 1his pegipit will he v ' Y
The Underground Utilities Coordinating Council (1-800-424-5555) must be contacted two (2) working days
before g w�����v.._K,._ ' ...,.,., sated with this hermit.
Name JAMES1JEF with an excavation associated � _ _.�... _��...�..- mmm.w�_. �� ...—-w-.wwww� w-.....�
p ssoc'
PERSON (SEFNCO C UNICATIONS—(COMCAST OF WA)
Address 4610 TACOMA AVE SUMNER WA
98390 Phone: (253)377-7017 1.
Pro osed st art in date of installation: 2/24 Duration: 3—DAYS UPON START DATE
�. � ........... _..__ ............. �....�.._
Date: 2/315 Signatur
I IRMIT q IiII:MI±NTS
For Official ial Use Only
._. . _a._ ..._. �_
Fee$ 0 m Issued
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p $ 0 Application Approval ' ' �h,A
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Fee Received
Recei t Number Signature .._ ..
ee........e........
To Be Completed By _ -...
Permission is hereby granted _m.... alp w. �
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ed to perform the above described work subject to the general provisions contained
on this form, and the followm special conditions
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,
A bond in the amount of _ m� is required to insure compliance with�,..._.mm...�..........___
lian with the above
conditions,refundable upon satisfactory completion of work.
No work shall be done under this permit until the party or parties to whom it is granted shall have
communicated with and received instructions
�.... ... .......................n_ ._. ..................
Re�rGarlw�s.
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n�............. .,... A. .-rorororo........ e.e.
Revised 03/09/2011
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fast Inspection Inspe ctor�Final Project I?ate
I}ate I t:Lrrtrlrlet*'art! it K a v�LB
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GENE RAL PROVISIONS A,PPLICA LE TO ALL PERMITS
In accepting this permit, the petitioner,his successor and assigns, agree to protect the CITY ,L ,
WASHINGTON, and save it harmless from all cla.irns, actions or damages of every kind and description which
may accrue to or be suffered by any person, or persons, corporation or property by reason of the performance of
any such work, character of materials used or manner-of installation, maintenance and operation or by the
improper occupancy or rights of way or public structure and in case of any suit or action is brought against said
City for damages arising out of or by reason of any commencement of such action, defend the same at his or
their sole cost and expense and will satisfy any judgment after the said suit or action shill have finally been
determined if adverse to the said City.
If the work done Linder this permit interferes in any way with the drainage of the area, the grantee shall wholly
and at his oven expense make such provisions as the City may direct to correct said drainage problems.
Upon completion of said work herein contemplated, all rubbish and debris shall be immediately removed and
from the roadway and roadside shall be left in a neat and presentable condition that is satisfactory to the City.
The party or parties to whom this permit is issued shall maintain at his or their sole expense the structure or
object for which this permit is granted in a condition satisfactory to the CITY OF YEL .
The CITY OF YELM may revoke, annul, change, amend, am p lify, or terminate this permit or any of the
conditions herein enumerated if grantee fails to comply with any or all of its provisions, requirements or
regulations as herein set forth or thru willful or unreasonable neglect, fails to heed or comply with notices given
or if the utility herein granted is not installed, operated, and maintained in conformity herewith or at all or for
any cause or reason whatsoever,
All work areas shall be adequately barricaded according to It UTC°D Standards. Barriers shalt be properly
lighted at night.
All trenches shall be backfilled with selected backfill materials unless otherwise directed by the Engineer.
PAVEMENT REPLACEMENT: Asphalt pavement shall be replaced to a minimum depth of four(4) inches
thick or match to the existing pavement whichever depth is greater° and to the dimensions specified by the
Engineer. In gravel alleys the permittee shall. replace base and surface rock.
All.work shall be conducted using current I A/OS A.regulations. Particular attention shall be paid to the
requirements as they pertain to work in trenches, electrical work, work in high places and to safety apparel such
as, hard hats and safety vests.
All work shall be completed to City Standards as set forth in the City of Yelm Development Guidelines, and
policies.
The PUBLIC WORKS DEPARTMENT office (360-458-8406) must be contacted for insVections 24 hours
before work commences.
Revised 03/09/2011
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