20160322 ROW Permit 09082016VA pf TII�p
a
City of Yelm
PUBLIC WORKS
901 Rhoton Rd NW
Yelm, WA 98597
Phone: 360- 458 -8406
FAX: 360- 458 -8417
Permit No. of
Application to Perform Work on
Public Right of Way and /or Connect
to Utilities
APPLICATION
The undersigned hereby makes application to:
DIRECTIONAL DRILL 200' ALONG E YELM AVE PLACING 2 -2" CONDUITS WITH COAX CABLE. PLACE A
NEW PREDESTAL ON LANDSCAPE OF E YELM AVE AND PRIVATE DRIVEWAY.
Location of work:
BURGER KING: 902 E YELM AVE
I agree to perform the work in strict compliance with Yelm Municipal Code, 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 I;nderground Utilities Coordinating Council (1- 800 - 424 -5555) must be contacted two (2) working day's
before proceeding _ with ny excavation associated with this _Eermit.
Name: Nathaniel Pinson
Address: 4610 Tacoma Ave, Sumner, WA 98390 TPhone: 253 - 370 -4209
Proposed starting date of installation: 9-1 -16 i Duration: 60 days
Date: 8 -26 -16 Signature:
PERMIT REQUIREMENTS
For Official Use Only
Fee $ ,00 Issued
Fee Received $ t ZS . `
Application Approval ,
Signature: e/
Receipt Number '"j 9
To Be Completed By Ci
Permission is hereby granted to perform the above described work subject to the general provisions contained
on this form, and the fqllowing s cial condi 'on :
..
z
r
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
Com letion Approval:
Date:
Revised 03/09/2011
r C�F�II�I�j� EP 0 8 201 !�)
- -----
City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: COMCAST
Address: 4610 TACOMA AVE
SUMNER WA 98390
Property Information:
Site Address: 902 YELM AVE E
Assessor Parcel No.: 99001818300 Subdivision:
Contractor Information:
Name: COMCAST
Address:
4610 TACOMA AVE
SUMNER WA 98390
Contractor License No.: Expires
Permit No.: 20160322
Issue Date: 10/20/2016
(Work must be completed within 180 days)
Phone: 253 - 370 -4209
Owner:
Lot:
Phone:
0 /00 /0000
Project Information:
Project: UTILITY
Description of Work: BURGER KING. DIRECTIONAL DRILL 200 FT ALONG E YELM AVE PLACING 2 2 IN
CONDUITS WITH COAX CABLE. PLACE A NEW PREDESTAL ON LANDSCAPE OF E YELM
AVE AND PRIVATE DRIVEWAY
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other)
Second
Third
Garage
Basement
Fees:
Item
RIGHT OF WAY
Contractor
COMCAST
TOTAL FEES:
Applicant's Affidavit:
I certify tha have read and examined the information contained within the application and know the same
to be true Ono correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm reg at ons including those governing zoning and land subdivision, and in addition, all covenants,
Basemen s a d strictio s of record. If applying as a contractor, I further certify that 1 am currently
reoistere in JhA State o ashington. A
Signature VVV - r I r ware IV w
Firm SePKICO
Fees
$ 125.00
$ 125.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cite of Yelp
(36 0 458 -3244
REC,# 00241594
OPER., CO TERM;
REro.' ; 55040
PAID 8 y:
TRAN: 33.0000
20160322
COMCAST
RON 902 YELM
TENDERED:
APPLIED:
00 1 02016 11: 10 AM
BUILDING PERMIT
125.o(CR
AVE E
125.O(CR
125'00 CHECK
125.00-
C'FIANGE:
0.00
"" 1,
City of Yelm
WCommunity
Development Department
to
Building Division
L
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: COMCAST
Address: 4610 TACOMA
AVE
SUMNER WA 98390
Property Information:
Site Address: 902 YELM AVE E
Assessor Parcel No.:
99001818300 Subdivision:
Permit No.: 20160322
Fee Calculation Worksheet
Phone: 253 - 370 -4209
Owner:
Lot:
Project Information:
Project: UTILITY
Description of Work: BURGER KING. DIRECTIONAL DRILL 200 FT ALONG E YELM AVE PLACING 2 2 IN
CONDUITS WITH COAX CABLE. PLACE A NEW PREDESTAL ON LANDSCAPE OF E YELM
AVE AND PRIVATE DRIVEWAY
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
RIGHT OF WAY PERMIT
Units Fees
1 $ 125.00
TOTAL FEES: $ 125.00
PAYMENTS MADE: $ 0.00
BALANCE DUE: $ 125.00
City of Yelm
Permit No. OLIV
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
Proposed starting date of installation: 9-1 -16 Duration: 60 days
Date: 8 -26 -16 Signature:
APPLICATION
The undersigned hereby makes application to:
DIRECTIONAL DRILL 200' ALONG E YELM AVE PLACING 2 -2" CONDUITS WITH COAX CABLE. PLACE A
NEW PREDESTAL ON LANDSCAPE OF E YELM AVE AND PRIVATE DRIVEWAY.
Location of work:
BURGER KING: 902 E YELM AVE
I agree to perform the work in strict compliance with Yelm Municipal Code, 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 proceedin with any excavation associated with this permit.
Name: Nathaniel Pinson
Address: 4610 Tacoma Ave, Sumner, WA 98390 Phone: 253 - 370 -4209
Proposed starting date of installation: 9-1 -16 Duration: 60 days
Date: 8 -26 -16 Signature:
PERMIT REQUIREMENTS
For Official Use Only
Fed e $ ,00 Issued
Fee Received $
Application Approval
Signature:
-RecelptNumber
To Be Completed By Ci
Permission is hereby granted to perform the above described work subject to the general provisions contained
on this form, and the followin s cial 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 A roval:
Date:
Revised 03/09/2011 FS'EP ICIET� 082016
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