HomeMy WebLinkAboutM_Paving Request_186576285_V1_170522' PUGET
SOUND
ENERGY
PAVING
REQUEST
ADDRESS: l(�l n ,
0 liu� �Ut A�� � ^.
TICKET: 5007725
PERMIT: C{glVWJ
SHEET: k OF
DECK: CITY: RE(PESTED BY-
rJ
INSIDE E] OUTSIDE P/I� POTELCO ElINFRASOURCE ❑ PSE
unj
DRAW LOCATION OF CUT AND NUMBER IT ACCORDINGLY:
P3 C\l
w
c^.n;sh 4ilc "E
2
N�.
MATCH #
FROM DRAWING
ABOVE
TYPE
(SEE KEY
BELOW)
SIZE
(CALLED
OUT)
DEPTH
IN INCHES
LOCATION
SIZE
(ACTUAL
INSTALLED)
Fxample 1
A
2 X 8
8"
25'N CIL Test St
AA to complete
! 2
YES
NO
TRAFFIC CONTROL
❑
❑
POLICE OFFICER
❑
❑
S t DIE
a L - 1r`. -
❑
NO PARKS
❑
❑
SHALLOW UTILITIES (LESS THAN 18")
❑
❑
1N RIGHT OF WAY
❑
❑
PRIVATE PROPERTY
❑
❑
UNDER TROLLEY LINES
❑
❑
FINAL TICKET FOR THIS JOB
❑
❑
EXTRAORDINARY NCC (OFFICE USE)
❑
❑
ADDED BY PAVING CONTRACTOR
TO TICKET#:
SAP ORDER NUMBER:
26f-.5
SAP NOTIFICATION NUMBER:
26
PM/PERSON RESPONSIBLE:
FORM FILLED OUT BY:
YES
NO
TRAFFIC CONTROL
❑
❑
POLICE OFFICER
❑
❑
PLATE OVER HOLE
❑
❑
NO PARKS
❑
❑
SHALLOW UTILITIES (LESS THAN 18")
❑
❑
1N RIGHT OF WAY
❑
❑
PRIVATE PROPERTY
❑
❑
UNDER TROLLEY LINES
❑
❑
FINAL TICKET FOR THIS JOB
❑
❑
EXTRAORDINARY NCC (OFFICE USE)
❑
❑
ADDED BY PAVING CONTRACTOR
TO TICKET#:
196712/11
LOCATE NUMBER:
f
DATE HOLE CLOSED: 5 _'�z — /7—
DATE AA RECEIVED:
AA LOCATE NUMBER:
KEY
C = CONCRETE IN STREET OR ALLEY (INCLUDING CURRANDGurrER)
C/WC = CONCRETE WHEEL CHAIR RAMP
C/SW = CONCRETE SIDEWALK, DRIVEWAY APPROACH
(INCLUDING CURB AND GUTTER)
C/G = CONCRETE CURB OR GUTTER
A = ASPHALT
A/C = ASPHALT OVER CONCRETE
G/O = ASPHALT GRIND AND OVERLAY
V = VALVE (RAISE VALVE AND REPAVE)
M = MISC (STRIPE, GRADING, ETC.)