20160283 ROW Permit 07112016N.tli�IZw +Y
City of Yelm
PUBLIC WORKS
901 Rhoton Rd NW
Velm, WA 98597
Phone: 360 - 458 -8406
FAX: 360- 458 -8417
Permit No. V.V&o zp;7
Application to Perform Work on
Public Right of Way and /or Connect
to Utilities
APPLICATION
The undersigned hereby makes application to:
Location of work:
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: L- r i J -L 0` --f 0Y 7
Address: r ` ��',� "" %�_ ;; Phone: ?a - o 33
Proposed starting date of installation: Duration: �, �,� <
Date:, %;, y_ f'
Signature:' {t� ' l
PERMIT REQUIREMENTS I
For Official Use Only
Fee $
Issued
Fee Received $
Application Approval
Signature:
Receipt Number VA-3-1G21
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
City of Velm
PUBLIC WORKS
901 Rhoton Rd NW
Velm, WA 98597
Phone: 360 -458 -8406
FAX: 360- 458 -8417
Permit No. b&o A?: 7
Application to Perform Work on
Public Right of Way and /or Connect
to Utilities
APPLICATION I
The undersigned hereby makes application to: =; a_ ,', f= _i %�►r7,�v 2 -t r 6 L/ioi!�
Location of work: ( fl U L tV'
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: ���.� <� <. ,ry � ���;- /' r�Sa- i ��� 70Lfbtf 7-
Address: y " `` P�. x Phone: Z o -
Proposed starting date of installation: L;,S. Duration:,
Date
Signature:
PERMIT REQUIRENttNTS
For Official Use Only
Fee $
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
City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: PSE INTOLIGHT
Address: 3380 146TH PLACE SE
BELLEVUE WA 98007
Property Information:
Site Address: 1 ST ST N
Assessor Parcel No.:
Contractor Information:
Name: PSE INTOLIGHT
Address: PAUL KINBERG
3380 146TH PL SE
BELLEVUE WA 98007
Contractor License No.:
Subdivision:
Permit No.: 20160283
Issue Date: 7/15/2016
(Work must be completed within 180 days)
Phone:
Owner:
Phone:
Expires: 0 /00 /0000
Project Information:
Project: UTILITY
Description of Work: REPLACE DAMAGED STREET LIGHT POLE RECENTLY HIT BY A CAR.
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
RIGHT OF WAY
Contractor
PSE INTOLIGHT
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 and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regul tion i uding those governing zoning and land subdivision, and in addition, all covenants,
easements and estrictions oo record. If applying as a contractor, I further certify that I am currently
registered i thE State of Washington.
Signature AN -r Date
Firm
Lot:
Fees
$ 125.00
$ 125.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Ci f�f of Yell
(361) 458 -3244
RECA': 00237554
OPER: CO TERM
REFS': 829738
PAID BY:
111512016 11 :34 AM
001
TRAM: 33.0000 BUILDING PERMITS
20160283 125.0(CR
PSE INTOLIGHT
1ST ST N
ROW 125.0(CR
1ENDERED: 125.00 CHECK
APPLIED: 125.00 -
CHANGE: 0.00
Applicant:
City of Yelm Permit No.: 20160283
Community Development Department Fee Calculation Worksheet
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Name: PSE INTOLIGHT, ATTN: PAUL KINBERG Phone: 206 - 604 -3346
Address: 3380 146TH PLACE SE, #310
BELLEVUE WA 98007
Property Information:
Site Address: 1ST ST N & STEVENS AVE NE Owner:
Assessor Parcel No.: Subdivision: Lot:
Project Information:
Project: UTILITY
Description of Work: REPLACE DAMAGED STREET LIGHT POLE RECENTLY HIT BY A CAR.
Item Units Fees
RIGHT OF WAY PERMIT 1 $ 125.00
TOTAL FEES: $ 125.00
PAYMENTS MADE: $ 0.00
BALANCE DUE: $ 125.00
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Karen Bennett
From: Kinberg, Paul A [paul.kinberg @pse.com]
Sent: Friday, July 01, 2016 12:13 PM
To: Karen Bennett
Subject: PSE ROW Permit Request
Attachments: 20160701115931557.pdf; 186572880.pdf
Hi Karen,
Hopefully I have the right email.
Please process ROW permit to replace PSE street light pole knocked down in a car
accident.
ROW permit and TCP attached.
Thanks
Paul Kinberg
Street Light Maintenance Supervisor
Contract Management
425.456 -26181 Paul.Kinberg P pse. com (LEC -OFC) Cell:
462-3149
338o 146th PL SE #310
PO 98007, Bellevue, WA
web: http: //intolight.com/
2o6 -604 -3346 Fax: 425-
Karen Bennett
From: Kinberg, Paul A [paul.kinberg @pse.com]
Sent: Tuesday, July 05, 2016 2:17 PM
To: Karen Bennett
Subject: RE: PSE ROW Permit Request
Sorry, I forgot to mention we still have some concrete patch work to be completed
here. thx
Paul Kinberg
Street Light Maintenance Supervisor
Contract Management
425.456 -2618 I Paul.Kinberg ftse.com (LEC -OFQ Cell:
462-3149
3380146th PL SE #310
PO 98007, Bellevue, WA
web: http:- intolight.com/
- - - -- Original Message---- -
From: Kinberg, Paul A
Sent: Tuesday, July 05,2o16 2:12 PM
To: 'Karen Bennett'
Subject: RE: PSE ROW Permit Request
Hi Karen,
The check is being sent.
2o6- 604-3346 Fax: 425-
This pole was actually already replaced last week. Please consider this an after the
fact emergency permit.
Thanks
Paul Kinberg
Street Light Maintenance Supervisor
Contract Management
425.456-2618 I Paul.Kinberg ftse.com (LEC -OFC) Cell: 206- 604-3346 Fax: 425-
462-3149
3380146th PL SE #310
PO 98007, Bellevue, WA
web: http:- fintolight.com/
- - - -- Original Message---- -
From: Karen Bennett [mailto:KarenB(-a)ci.yelm.wa.us]
Sent: Friday, July 01, 201612:20 PM
To: Kinberg, Paul A
Subject: RE: PSE ROW Permit Request
Good Afternoon Paul. Got your application ready to process. There is a $125.
application fee that must be paid before Public Works reviews this application. If you
are sending in a check please address it to me at City of Yelm and I will get things
going right away. Thanks and have a great 4th of July weekend!!
Karen T. Bennett
105 Yelm Ave W
Yelm, WA 98597
(360)458-3835
karenb(&ci.yelm.wa.us
- - - -- Original Message---- -
From: Kinberg, Paul A [mailto: paul.kinbergOpse.com 1
Sent: Friday, July 01, 2016 12:13 PM
To: Karen Bennett
Subject: PSE ROW Permit Request
Hi Karen,
Hopefully I have the right email.
Please process ROW permit to replace PSE street light pole knocked down in a car
accident.
ROW permit and TCP attached.
Thanks
Paul Kinberg
Street Light Maintenance Supervisor
Contract Management
425.456 -2618 I Paul.Kinberg(&pse.com (LEC -OFQ Cell: 206 -604 -3346 Fax: 425-
462-3149
3380146th PL SE #310
PO 98007, Bellevue, WA
web: http:yintolight.com/