HomeMy WebLinkAboutA_FranchisePermitApplicationN.116993_170418_v1DEPARTMENT OF COMMUNITY AND ECONOMIC DVELOPMENT
DEVELOPMENT SERVICES DIVISION
MASTER USE/FRANCHISE UTILITY PERMIT APPLICATION
Phone: (425) 430-7266 Fax: (425) 430-7231 franchise@rentonwa.gov
TO THE APPLICANT: Submit 3 copies of plans with application. Permit cost is $360.50. Inspection fee for
trenching more than 60 lineal feet or installation of 6 or more poles will be billed at $60.00 per hour.
For City Use Only
CITY PERMIT NO: MFP___________________ WORK ORDER NO.: _____87029__________
Date of Application: Franchise Agency:
Mailing Address for Permit: Zip:
Contact Name: Phone:
Job Number: e-mail:
Job Site Address: Project Name:
Description of Work:
Please check all that apply:
New Construction Repair/Relocate Underground Overhead Sidewalk Street
Open trench Bore # of feet: __________ Gas Electric Other: ______________________
Estimated Job completion date:
Contractor name: Phone:
City of Renton Business License Number: State Contractors License Number:
“I certify that I am the applicant’s owner or authorized agent and do hereby agree to abide to the terms and conditions set forth
under this permit and shall comply with the City of Renton’s Trench Restoration and Street Overlay Requirements. ”
Signature Date
CITY INSPECTOR SHALL BE NOTIFIED 24 HOURS PRIOR TO COMMENCEMENT OF ALL WORK
BY CALLING THE INSPECTION LINE AT 425-430-7203
Jobs are required to be called in for job start, re-inspection and project final.
Approved as Submitted
Plan Review/Development Services Date On-Site Pre-Con Required
Approved with Comments or Redlines
Traffic Control Plan Attached
Utility Inspector Date Camera Inspection of Utilities Required
Issue Date:
Public Works Permit Supervisor Date Permit expires 6 months from issue date
2/13
861