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20170179 ROW Permit Pkg 05022017City of Yelm PUBLIC WORKS 901 Rhoton Rd NW Yelm, WA 98597 Phone: 360- 458 -8406 FAX: 360 - 458 -8417 Permit No. O 1-7 9 Application to Perform Work on Public Right of Way and /or Connect to Utilities APPLICATION The undersigned hereby makes application to: Cut and Cap (retire) gas service @ 33'S of CL West Yelm Ave and 247' E of CL Killion Rd 2x4 soft surface cut in right of way. (grass). Location of work: 810 West YeIm Ave Job #108596920 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/ InfraSource Mary McCorkle mary.mccorkle @pse.com Address: 3130 South 38th St, Tacoma 98409 Phone: 253-476-6037 Proposed starting date of installation: 5/15/17 Duration: 1 Day Date: 4 /20/17 Signature: mc PE REQUIREMENTS For Official Use Only Fee $ (ZS — Issued Fee Received $ 1245 _ Application Approval Signature: Receipt Number 00 ?,(o -7 p 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 com letion 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: 17 77 57 Revised 03/09/2011 " , : , 12011 BY: -------------- - - - - -- ti City of Yelm PUBLIC WORKS 901 Rhoton Rd NW Yelm, WA 98597 Phone: 360- 458 -8406 FAX: 360- 458 -8417 Permit No. O 1-7 '11 Application to Perform Work on Public Right of Way and /or Connect to Utilities APPLICATION The undersigned hereby makes application to: Cut and Cap (retire) gas service @ 33'S of CL West Yelm Ave and 247' E of CL Killion Rd 2x4 soft surface cut in right of way. (grass). Location of work: 810 West Yelm Ave Job #108596920 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/ InfraSource Mary McCorkle mary.mccorkle @pse.com Address: 3130 South 38th St, Tacoma 98409 1 Phone: 253-476-6037 Proposed starting date of installation: 5/15/17 Duration: 1 Day Date:4 /20/17 Signature: M-0VU4MCUU4L---- PE REQUIREMENTS I For Official Use Only Fee $ (ZS — Issued Fee Received $ 1 Z, � Application Approval Signature: Receipt Number 0o 2,(p -7570 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 0 12017 BY: -------------- - - - - -- „ev. 1!un;� 20 "�3 -_E ` ._; LC :C,F� Job: Ad'dress: _.ID W_�!� _.lY33al_m - - -= --- - - - - -- Jurisdiction: _ -- — _ -- City /7_ip: ---- .-- _ - -_ -- Est. Start Date: Cus'cmer: - CuSio';,n6k!'HJrv_ IdUMtl[n 1,`,'o rh D e sc! i o ti on 1 v_�` r —g� — - —C— c —ns-- t r—uc—: - i— on — — iMei,cr, —Pic— ) Open Trench ❑ I -- Trenchless ❑ I i Work Location Sun =ace f CL P�s,L- &.'! 1N of CL lto,h 12.C• �oL �rs� - - = -- _ _'N 5 of CL & 'E W of CL_ Flaggers [_f }; Polire Flaggers Trolley Lines [] —Bus Sto- � ❑ `- �- ❑ � f',rieier 000s � I Speeo' Limit ❑'# rn� Tra�Fic Signal ❑ P,r'ierial f�lo Parts ❑ *? Commercial ❑Altered Commercial ❑Leak Repair ❑ %esidential ® Altered Residential ❑ CP Work ❑ _❑ __ Service Information Bollards LI2.5 " ❑4 "# Diameter Meter Multi - Family❑ Replacement Service❑ Pothole ❑ EFV Template Bar [❑ 5/8" ❑ 250 CIS 0 0 ❑Fuel Line Permit ❑ New Service ❑ Main Maintenance ❑ Extension ❑ 21/8"D425 ❑ 2600 ❑ Fuel Line Length I Stub ❑ ServFCe Maintenance❑ Complete p 1 1 4" ” / ❑; 630 ❑ 10,000❑ Fuel Line Diam. Cut & Ca Cap XrValve Maintenance ❑ Service ❑ 2" ❑ 1000❑ Meter Location aim, plp� 00 ol U') Iq 14 C14 C,4 10 rn C 0 AK V) —j .2 0 > 0 Ns c: C3 1 E in Ct oo EgS 0)00 N aim, plp� 00 ol U') Iq 14 C14 C,4 10 rn C 0 AK V) —j .2 0 > 0 Ns c: C3 1 E in Ct (D (V EgS 0)00 N C3 fief U co CN a) (Q Z0CD C4 6 § 0 CO C4 i- z Z ° o� W N n V_ O m > o N � Q o J O r O O a ° = AUM 33S - 3NnH31M9 3 } W IJ,1 N v 3 p m o Q W tY U to O ~ n > 3 cn lo MR IL m 2 U Y Y 0 d t W o K U cm U 3 3 a � i �dV w i7e 1i i� E.� lot mx mw 03501) nr= O A W Ntll tl3L43^ „wee 3 ® aQ N FR�i h M r € zd --MN 1S a ® MltlA13018 v; 3AOGV 33S - 3NnHa1VR . ab a t SIIDMALK a CLOSED 3 a0w 1. ® M 3S 0A18 VW0HV1 J ZW m U a �W Q z rn z U i = m m tn O W 1 W < WO w go zWQOa ��w� rn Na I-> O W N W M W O J Q= O Z V = O N J z n -o Q� Z S i m o z N U N o � , w Z N, a O Z j� F} Q QU (�DJ m m�Z gfN/I�OUW mOKQti N Q N z0 Q 2 Z 2 m K j H N a 0 K VI ° °zQU .3r-o. rmQ Z�� zw�-L ?IQ -�c� N�acYiz � °��c�i cDw °Qrn UN>ZZ W3W��= �Z O N KWN yajUOJa lWmmul �N1Yd� ZUJmZ Wy ONO0a�uiWmZUaLL4432mz �zogZJJJJF° aow3W Q J Z~ 2 0 m � a N Q 0� N a D= d J� ZZ FO �W WWZ� mJ�OSa OU¢a. 0' VIO QZ Zm NOOIN/1 <� 0 WZYMWI~/1KY0 IWjjJQOaQ_JJ � 0<<, Wmmm ZG�W -U 0OF=OZ OUrrO�Z O UOZ WOD=J Q m — K 00�ZU Q3 QLUm3m UN Z J Y F O Z— r m�iwli[R�w<�vMai aemilwx4ie � -Mw Vo�^!�MTAna- City of Yelm Community Development Department Building Division Phone: (360) 458 -8407 Fax: (360) 458 -3144 Applicant: Name: PUGET SOUND ENERGY INFRASOURCE Address: 3130 S 38TH ST TACOMA WA 98409 Property Information: Site Address: R1 n YFI M AVF W Assessor Parcel No.: Subdivision: Contractor Information: Name: PUGET SOUND ENERGY INFRASOURCE Address: 3130 S 38TH ST TACOMA WA 98409 Contractor License No.: Permit No.: 20170179 Issue Date: 5/02/2017 (Work must be completed within 180 days) Phone: 253 - 476 -6037 Owner: Lot: Phone: Expires: 0 /00 /0000 Project Information: Project: UTILITY Description of Work: CUT AND CAP, RETIRE, GAS SERVICE AT 33 FT S OF CL WEST YEL AVE AND 247 FT E OF CL KILLION RD. 2X4 SOFT SURFACE CUT IN ROW, GRASS. Sq. Ft. per floor: First Heat Type (Electric, Gas, Other): Second Third Garage Basement Fees: Item Contractor RIGHT OF WAY PUGET SOUND ENERGY INFRASOURCE 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 n correct. I also certify that the proposed structure is in conformity with all applicable City of Yelm regu tions including those governing zoning and land subdivision, and in addition, all covenants, easement an estr ion of record. If a ying as a contractor, I further certify that I am currently registered 'n t a e f ashington. ^� Signature Date - 7 Firm m t^ �r SCiu.�0 -,. Fees $ 125.00 $ 125.00 OFFICIAL USE ONLY # Sets of Prints: Final Inspection: Date: By: Ci� of Yolm (36 1) 458 -3244 RECk: 00267501 5/02/2017 C:U9 AM OPEF': CO TERM: 001 REFA: 845844 PAID BY: TRAN: 33,0000 BUILDING PERMITS 20170179 125.0(CR PUGET SOUND ENERGY ]NFRASOURCE 810 YELM AVE W ROW 125,0tCR IRAN: 33,0000 BUILDING PERMITS 20170180 125.0(CR PUGET SOUND ENERGY JNFRASOURCE 215 MOSMAN AVE SE ROW 125,0(CR 1ENDERED: 250.00 (HECK APPLIED: 250,00 - CHANGE: