20160311 ROW Permit 08092016City of Yelm
Permit No. ki.t�(00 JNI
PUBLIC WORKS
Location of work: W Yelm Ave, Cullens St NW
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
Duration:
APPLICATION
The undersigned hereby makes application to:
Overlash 362' and Attach 448' of new %" strand along with a 24ct Fiber Optic Cable. We plan to run this fiber on Yelm Ave SW for
362', then go North on Cullens St for 448'. Underground will consist of a new Vault on Cullens St, see attached plans for details.
Location of work: W Yelm Ave, Cullens St NW
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: Astound Broadband, LLC
Address: 401 Parkplace Center, Suite 500, Kirkland, WA, 98033
Phone: 206 - 765 -0915
Proposed starting date of installation:
Duration:
Date:
Signature:'
PERMIT REQUIREMENTS
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 ins
conditions, refundable upon satisfactory completion of work. 50 't
No work shall be done under this permit until the party or parties to wh
communicated with and received instructions from:
Remarks:
First Inspection
Date:
Inspector Final Project
Completion Approval:
Date:
Revised 03/09/2011
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WAVE CONTACTS
CONSTRUCTION MANAGER:
NAME: Paul Walk
TELEPHONE: 509.499.6323
EMAIL: pwalk @wavebroadband.com
PROJECT MANAGER:
NAME: Matthew Travis
TELEPHONE: 206.765.0915
EMAIL: mtravis @wavebroadband.cam
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■ NEW 17 X3C
VAULT
OVERLASH
ALONG WITH
NEW 24 COUNT
PROJECT NUMBER: 1784 -16 -1020
JOB NAME: Yelm Medical
LOCAT ON:
Yelm Ave w Cullom st NW
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: ASTOUND BROADBAND, LLC
Address: 401 PARKPLACE CENTER, STE 500
KIRKLAND WA 98033
Property Information:
Site Address: rill I FNS RT NW
Assessor Parcel No.:
Contractor Information:
Name: ASTOUND BROADBAND, LLC
Address:
401 PARKPLACE CENTER, STE 500
KIRKLAND WA 98033
Contractor License No.:
Project Information:
Project: UTILITY
Description of Work:
Permit No.: 20160311
Issue Date: 0 /00 /0000
(Work must be completed within 180 days)
Phone: 425 - 256 -0547
Owner:
Subdivision: Lot:
Phone:
Expires: 0 /00 /0000
OVERLASH 362FT AND ATTACH 448 FT OF NEW QUARTER INCH STRAND ALONG WITH A
24CT FIBER OPTIC CABLE
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Fees:
Item
RIGHT OF WAY
Heat Type (Electric, Gas, Other):
Contractor
ASTOUND BROADBAND, LLC
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 regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor, I further certify that I am currently
registered in the State of Washington.
Signature Date
Firm
Fees
$ 125.00
$ 125.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By: