2014-16B ROW Permit 10152014 City of Yelm Permit No. 2014-16
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
FAX: 360-458-8417
APPLICATION
The undersigned hereby makes application to:
Overlash (1) 36ct fiber cable 2762' to existing Comcast strand.
Bore 9' under grass/sidewalk area, install (1) 4" conduit & pull (1) 12ct f-,ber cable 9 .
..........
ME JT#123347
Location Of WOCk: 624 Crystal Springs St NW Yelm, WA 98597
I agree o Pe work i
ee perform die wn strict compliance with Yelm Municipal Code,Chapt
� p er ,the special
conditions enumerated herein and the attached conditions I have read and will adhere to the general provisions
applicable to permits contained on this form.
The Public Works Department((360-458-8406)must be contact r�d f t° inspection I4 hours beforem
rt°rank
commegees or th"s ermit will be void.
before Underground
in with ie excavation associated IT _ onto _. ._.._,
The Underground Utilities Coordinating Council(1-800-424-SSSS)must be contacted two(2)working days
p „ p w with this permit,
Name: Comcast of WA, IV Authorized Agent: Eclipse Engineering
Valley Ave NW Puyallup WA 98371 Phone: 253-235 7020
Proposed starting
Address: 410
inn Cl.au of installation 12/3/14 Duration: 5 days
Date: 10/15/14 Signature:
PERM-IT RE2UIREMENT S
For Official Use Only
-. ..�.—
Fee$ Issued
Fee RFen...c..�eived$ Application Approval
Receipt Number ._�...�. Signature:
. .__.... _
�..... .
To Be+Com lcted II Ci __
Permission is hereby granted to perform the above described work subject to the general provisions contained
n and the followia�P,special conditions:
on this form
A bond in the amount of is required to insure compliance with the above
conditions, refundable u on satisfacto 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 from:
Remarks:
First Inspection �.� �... . �
F ate: pector Final Project Date.
Completion Approval;
Revised 03/09/2011