20160264 ROW Permit 06242016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: COMCAST OF WASHINGTON
Address: 410 VALLEY AVE NW
PUYALLUP WA 98373
Property Information:
Site Address: 01d4 DDAIDIG WlKlln CT CG
Assessor Parcel No.: 64410001300
Contractor Information:
Name: COMCAST OF WASHINGTON
Address: ROE MORRIS
410 VALLEY AVE NW
PUYALLUP WA 98373
Contractor License No.:
Project Information:
Project: UTILITY
Description of Work:
Permit No.: 20160264
Issue Date: 7/21/2016
(Work must be completed within 180 days)
Phone:
Owner:
Subdivision: MCKENZIE MEADOWS Lot: 13
Expires
Phone:
0 /00 /0000
TRENCH /BORE 93 FT IN RIGHT OF WAY AND PLACE 2 INCH PVC. BEGIN TRENCHING 13
FT FROMCATV PED SE CORNER OF 9331'S PROPERTY TO BORE 24 FT UNDER 933TS
DRIVEWAY AND CONTINUE TRENCHING 56 FT TO PLACE A 9 INCH FLUSH MOUNT
CARSON BOX.
Sq. Ft. per floor:
First
Second
Third
Garage
Basement
Fees:
Item
RIGHT OF WAY
Heat Type (Electric, Gas, Other):
Contractor
COMCAST OF WASHINGTON
TOTAL FEES:
Applicant's Affidavit:
I certify that I have read and examined the information contained within the application and know the same
to be true a d correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regul 'ions ncludiipohose governing zoning and land subdivision, and in addition, all covenants,
easements nd e tri�ons'W record. If applying as a contractor, I further certify that I am currently
registered i th to of Mshingto
Signature Date
p I
Firm �( JaU,_ (L
Fees
$ 125.00
$ 125.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: COMCAST OF WASHINGTON
Address: 410 VALLEY AVE NW
PUYALLUP WA 98373
Property Information:
Site Address: 9343 PRAIRIE WIND ST SE
Assessor Parcel No.: 64410001300 Subdivision:
Project Information:
Project: UTILITY
Description of Work:
Sq. Ft. per floor:
Fees:
Item
RIGHT OF WAY PERMIT
Permit No.: 20160264
Fee Calculation Worksheet
Phone:
Owner:
MCKENZIE MEADOWS Lot: 13
TRENCH /BORE 93 FT IN RIGHT OF WAY AND PLACE 2 INCH PVC. BEGIN TRENCHING 13
FT FROMCATV PED SE CORNER OF 9331'S PROPERTY TO BORE 24 FT UNDER 933TS
DRIVEWAY AND CONTINUE TRENCHING 56 FT TO PLACE A 9 INCH FLUSH MOUNT
CARSON BOX.
First Heat Type (Electric, Gas, Other)
Second
Third
Garage
Basement
��(36 5a
44
1) 3:06 PM
CD 1/2A/20 1b
RE': 00'Z30315 TERM:
001
OPEF. 14174
REFS' :
PAID
BY
33,ILDING PERMITS
0000 6U
IRAN : 125 ,0(CR
20160264
9343 PRA RI A WIND SIN SE
9343 125.0(CR
ROW
125 00 (HECK
TENDERED: 125.00 -
APPLIED
CHANGE.,
Units
1
TOTAL FEES:
PAYMENTS MADE:
BALANCE DUE:
$ 125.00
$ 125.00
$ 0.00
$ 125.00
City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: COMCAST OF WASHINGTON
Address: 410 VALLEY AVE NW
PUYALLUP WA 98373
Property Information:
Site Address: 9343 PRAIRIE WIND ST SE
Assessor Parcel No.: 64410001300 Subdivision
Project Information:
Project: UTILITY
Description of Work:
Sq. Ft. per floor:
Fees:
Item
RIGHT OF WAY PERMIT
Permit No.: 20160264
Fee Calculation Worksheet
Phone:
Owner:
MCKENZIE MEADOWS Lot: 13
TRENCH /BORE 93 FT IN RIGHT OF WAY AND PLACE 2 INCH PVC. BEGIN TRENCHING 13
FT FROMCATV PED SE CORNER OF 9331'S PROPERTY TO BORE 24 FT UNDER 9337S
DRIVEWAY AND CONTINUE TRENCHING 56 FT TO PLACE A 9 INCH FLUSH MOUNT
CARSON BOX.
First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Units
1
TOTAL FEES:
PAYMENTS MADE:
BALANCE DUE:
Fees
$ 125.00
$ 125.00
$ 0.00
$ 125.00
1`.
,r
City of Yelm
PUBLIC WORKS
901 Rhoton Rd NW
Yelm, WA 98597
Phone: 360 - 458 -8406
FAX: 360- 458 -8417
Permit No. Amcgbu
Application to Perform Work on
Public Right of Way and /or Connect
to Utilities
APPLICATION I
The undersigned hereby makes application to: 1 rerxch q3' trA rlyl maLe-
ir4nohino 13' 'Prom CAT V qt8 SE carner o; 331A r + 0
bore 2q' C133-7,3 drf CA r c i S(o' to
l " -f=' o e c
Location of work: 8343 Pr0.t i il'1d 3+ SE Gorylcwf Job# 26q sr-7
I agree to perform the work in strict compliance with Yelm Municipal Code, Chapter 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 contacted for inspection 24 hours before work
commences or this permit will be void.
The Underground Utilities Coordinating Council (1- 800 - 424 -5555) must be contacted two (2) working days
before proceeding with any excavation associated with this permit.
Name: COM k 1 rt A--rr tAorr-vs
Address:y/p Valify Ave " .fit P &)y-atlop 9 373 Phone: Z�3-
Proposed starting date of installati : 'T QS I(o Duration: 2
Date:��
Signature:Kzpt'
PERMIT REQUIREMENTS
For Official Use Only
Fee $ �i�.
Issued
Fee Received $
Application Approval
Signature:
Receipt Number
To Be Completed By City
Permission is hereby granted to perform the above described work subject to the general provisions contained
on this form, and the following special conditions:
A bond in the amount of is required to insure compliance 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 from:
Remarks:
First Inspection
Date:
Inspector Final Project
Completion Approval:
Date:
Revised 03/09/2011
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