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20160313 ROW Permit 08262016City of Yelm PUBLIC WORKS 901 Rhoton Rd NW Yelm, WA 98597 Phone: 360- 458 -8406 FAX: 360- 458 -8417 Permit No. 2o / (o o 31 3 Application to Perform Work on Public Right of Way and /or Connect to Utilities APPLICATION I The undersigned hereby makes application to: J'`I� -To bK-0 -W-4500t 6 Ig's 170P 11 PbK' ' v1J pit-% C4 DTInl U� �IClt1 F S l� ill Td GONI Cr U - Location of work: goo $'�-� tINCS I �L tiA _ 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: Address: JID E VW FA—p (, S'f6- Imo- 1411 hone: as3 j Proposed starting date of installation: &Ili 211 l i Duration: o-1 - Date: !b la 1La Signature: • �� il1J�� M ' end PERMIT REQUIREMENTS I For Official Use Only Fee $ 02 °O 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: COMCAST OF WASHINGTON Address: 410 VALLEY AVE NW PUYALLUP WA 98373 Property Information: Site Address: 908 CRYSTAL SPR RD NW Assessor Parcel No.: 22719210405 Subdivision: Project Information: Project: UTILITY Permit No.: 20160313 Fee Calculation Worksheet Phone: Owner: Lot: Description of Work: OPEN TRENCH, BORE 61 FEET IN RW AND PLACE 2 INCH PVC. TRENCH 34 FEET FROM POLE NW CORNER OF 912'S PROP. BORE 22 FEET UNDER DRIVEWAY AND CONTINUE TRENCHING 5 FOOT TO REPLACE A DAMAGED CATV SERVICE LINE. COMCAST JOB NO. 213845 Fees: Item Units Fees RIGHT OF WAY PERMIT 1 $ 125.00 TOTAL FEES: $ 125.00 PAYMENTS MADE: $ 0.00 BALANCE DUE: $ 125.00 0. Q. I ca CD O e "-L/!;:ld S g,v s sr A.IJ rr [C] CvJ —_ dftw k' waft ftft CP- O • o V I' I f \ ®§ / \\ � .; k jj ��® 2 �� °»§ g ui cc % «!!§ IL § � d S - �k (k( § m a =y� s _ ! /� )LU _ § § )� k \ § e\ ! § \ ()) ) i! g !U. /2 E ! 2 °° �k LU w �! \ � k\§ma ��p « z B�» k . � \ � � � . ° ( ! e ; ° \ CL F- 0 0 i f §� § , b k��•\ � � © o !/ , � ui - |` • ■| , 0 m ®`@ / ma;\ ; t z m e §/! - -- | \ � � ■ ■§ ; § : cc 2 - § 2 _ - \ §§ � _ 2E: K § a § § d \k�] U'. \ }�) \@�\ n ow a•� ap |■E§�§ \ ®§ / \\ � .; k jj ��® 2 �� °»§ % «!!§ § � d S - �k (k( § m a =y� s _ /� _ § )� ) \2� § e\ ! § \ ()) ) i! 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: 908 CRYSTAL SPR RD NW Assessor Parcel No.: 22719210405 Subdivision: Project Information: Project: UTILITY Permit No.: 20160313 Fee Calculation Worksheet Phone: Owner: Lot: Description of Work: OPEN TRENCH, BORE 61 FEET IN RW AND PLACE 2 INCH PVC. TRENCH 34 FEET FROM POLE NW CORNER OF 912'S PROP. BORE 22 FEET UNDER DRIVEWAY AND CONTINUE TRENCHING 5 FOOT TO REPLACE A DAMAGED CATV SERVICE LINE. COMCAST JOB NO. 213845 Fees: Item Fees RIGHT OF WAY PERMIT 1 $ 125.00 TOTAL FEES: $ 125.00 PAYMENTS MADE: $ 0.00 BALANCE DUE: $ 125.00 City of Yelm PUBLIC WORKS 901 Rhoton Rd NW Yelm, WA 98597 Phone: 360- 458 -8406 FAX: 360- 458 -8417 Permit No. 2 o/ (o o 313 Application to Perform Work on Public Right of Way and /or Connect to Utilities APPLICATION The undersigned hereby makes application to: J6'jf10 TU Mtfi 1 i> 6 �C— LP I ' I nl � � C • 1 'f Ctrl 34' til N COR -NEB- � F ; 's O OK ' W DK-1V CEtJmrn ut� -W6C4f1 F s T6 044mry Owq GCY41 W U - Location of work: 00 CAIST-N— ONCS, I agree to perform the work in strict compliance with Yelm Municipal Code, Chapter , the specia 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: T> 10 Address: JID qNAVJ ME WyJ �W Cj C sJ-6, p,pol hone: 9,�-3 • �3 Proposed starting date of installation: 41 112J ILI I Duration: a . Date: !� '� 1� Signature: • C��I�C� =� PERMIT REQUIREMENTS For Official Use Only Fee $ a °O 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: T 5� Revised 03/09/2011 Vu v . - -. AUG 2 4 2016 BY- -------------- - - - - -- q. .1 SJ;4,yS nr AJJ m e) O U D i I \�) } � \\ • k (( \ LLJ | ( 2 | \k a ! (� ! � § (�� ( \ � � \ } \( / \ ! § / \ §( ) ) ui K § ( ))) § §! 2 UJ \ E ( ! ° z ` " } ° ° @� �\ !! !k � Ix / \2� ` LU w w \ \ /ea ' Z » U ) ® B�! k ©` q / . -i luu \ ■ ` o 0 � q § _ \ , w ja )\ § I )§ § a ! ;¥�' d k ( • ■ § , # ;\\ T _ \ ■■§ ; §§ _ »g■ 2 ! ! e7777/ ik § {§§ ! ! . k § - § }(\ 2 ' ■ 2 |!� _ __ g | d 2 T. }}�( \ }kk 1 @ /k! - = §§ § §/ ol E, �K|| §|§|0 \�) } � \\ • k (( | ( 2 | \k a ! (� � (�� \ } \( / \ � �( / \ §( § j§ K § ( ))) § §!