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ECONOMICANDCOMMUNITYDVELOPMENTDEVELOPMENTSERVICESDIVISIONMASTERUSE/FRANCHiSEUTILITYPERMITAPPLICATIONPhone:(425)430-7266Fax:f425)430-7231franchise@rentonwa.govTOTHEAPPLICANT:Submit3copiesofplanswithapplication.Permitcostis$360.50.Inspectionfeefortrenchingmorethan60linealfeetorinstallationof6ormorepoleswillbebilledat$60.00perhour.ForCityUseOnlyCITYPERMITNO:WORKORDERNO.:87029DateofApplication:-2F17FranchiseAgency:(‘t..itt.S+Address:1/OtiaIly4veOW..%t1?kf%-4/dtZip:9837/ContactName:/1(AJ.-CVPhone:?-5?9Z5?’JobNumber:e-mail:1fl_1A.’mLcredI’JobSiteAddress:3/’fParrp4w’0.ProjectName:-r4OPIDescriptionofWorkP(4€ê2”-t.-I-e.tdi4’-ku-e,,&rke4A)2c4—-.nPleasecheckallthatapply:lUndergroundElOverheadElSidewalkElStreetElNewConstructionElRepair/Relocate[1opentrenchElBorelI#offeet:I1?O’ElGasElElectricElOther:EstimatedJobcompletiondate:______________________Contractorname:________________________________________________________Phone:CityofRentonBusinessLicenseNumber:StateContratorsLicenseNumber:_____“IcertifythatIamtheapplicant’sownerorauthorizedagentanddoherebyagreetoabidetothetermsandconditionssetforthunderthispermitapallomplwiththeCityofRenton’sTrenchRestorationandStreetOverlayRequirements.”Signature__________________________________________________________Date______________________CITYINSPECTORSHALLBENOTIFiED24HOURSPRIORTOCOMMENCEMENTOFALLWORKBYCALLINGTHEINSPECTIONLINEAT425-430-7203Jobsarerequiredtobecalledinforjobstart,re-inspectionandprojectfinal.7Le’,x,toIepo,-nr.Jive,C/o—i.t,yiO’Atrk-A-u’,1].?2,g1_____________________________________________ElApprovedassubmittedPlanReview/DevelopmentServicesDateElPre-conrequiredElApprovedwithcommentsorredlines___________________________________________ElApprovedTrafficControlPlanRequiredUtilityInspectorDateElDenied______________________________________________________________________________IssueDate:_________________________PublicWorksPermitSupervisorDatePermitexpires6monthsfromissuedate10/2011MFP17003440Holly PowersJustin Johnson7-24-20177/24/2017