20160337 ROW Permit 09282016a-
City of YOM
PUBLIC WORKS
901 Rhoton Rd NW
Yelm, WA 98597
Phone: 360- 458 -8406
FAX: 360 - 458 -8417
Permit No. got ooi3
Application to Perform Work on
Public Right of Way and /or Connect
to Utilities
APPLICATION
The undersigned hereby makes application to:
Work in ROW to install new v erhead to underground ele ri r ice.
No asphalt cut /Trench - Approx. 4' in soft surface ROW
Pr ct Mana er mer n nt ct: Am y Smith 3 -
Location of work: 1416 C stal S rin s St. N.W.
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
to permits contained on this form.
—applicable
on
The Public Works Department (360- 458 -8406) must be contacted for inspecti 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 an excavation associated with this permit.—
Name: Puget Sound Energy/ Potelco INC
Address: 2711 Pacific Ave. S.E. Olympia,
WA 98501 Phone: 253 306 -2255
Proposed starting date of instal lati
29/16 I Duration: 1 day
Dater e� I
rJU
Signature:
PERMIT REQUIREMENTS
For Official Use Only
Fee $
Issued
Fee Received $ Z ,
Application Approval oe
Signature:
Receipt Number ., 2L{
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 A royal:
Date:
Revised 03/09/2011
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1� SEP 2 E 2016
BY.......... ..........
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City of YOM
PUBLIC WORKS
901 Rhoton Rd NW
Yelm, WA 98597
Phone: 360 - 458 -8406
FAX: 360- 458 -8417
Permit No. oLV�%� �3
Application to Perform Work on
Public Right of Way and /or Connect
to Utilities
APPLICATION
The undersigned hereby makes application to:
W ork in install new overhead to und r r n 1 ri c service.
No asphalt cut /Trench - Approx. 4' in soft surface ROW
Pr ct Manager/Emergency Contact: Am Smith 543-3531
Location of work: 1416 Crystal Springs St. N.W.
u Z
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: Puget Sound Energy/ Potelco INC
Address: 2711 Pacific Ave. S.E. Olympia, WA 98501 Phone: 253 306 -2255
Proposed starting date of installati 09/29/16
1 Duration: 1 day
Date: -,7 l
1 U
Signature: 2A
PERMIT REQUIREMENTS
For Official Use Only
Fee $ JZS . "—
Issued
Fee Received $ Z
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 A roval:
Date:
Revised 03/09/2011
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City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: PUGET SOUND ENERGY OLYMPIA
Address: 2711 PACIFIC AVE SE
OLYMPIA WA 98506
Property Information:
Site Address: 1A1R rPYSTAI -RPR RIB NW
Assessor Parcel No.:
Contractor Information:
Name: PUGET SOUND ENERGY OLYMPIA
Address:
2711 PACIFIC AVE SE
OLYMPIA WA 98506
Contractor License No.:
Subdivision:
Permit No.: 20160337
Issue Date: 9/28/2016
(Work must be completed within 180 days)
Phone: 253 - 306 -2255
Owner:
Lot:
Phone:
Expires: 0 /00 /0000
Project Information:
Project: UTILITY
Description of Work: WORK IN ROW TO INSTALL NEW OVERHEAD TO UNDERGROUND ELECTRIC SERVICE.
NO ASPHALT CUT OR TRENCH. APROX 4 FT IN SOFT SURFACE ROW. JOB NO.
104284521
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Fees:
Item
RIGHT OF WAY
Heat Type (Electric, Gas, Other):
Contractor
PUGET SOUND ENERGY OLYMPIA
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 resfrIch of record. If applying as a contractor, I further certify that I am currently
registered in the S to of Washington.
Date
Firm
Fees
$ 125.00
$ 125.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
CIf�of Yelm
(36 )) 458 -3244
REC#. 00244949 9/28/2016
OPER: CO TERM: 001 1:50 PM
REFk: 833040
PAID By:
IRAN: 33.0000 BUILDING PFRMII'.3
20160337 7
PUGET SOUND ENERGYO(�YMpIA
ROW 1416 CRYSTAL SPR RD NW
125.0(CR
1ENDERED: 125.00
APPLIED: CHECK
125.00-
CHANGE: '- -`�- -- -
0.00