HomeMy WebLinkAboutA_Francshise_Permit_Revision_N.259330_180130_v1DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
Page 1 | Published: 3/30/2017
Planning Division | 1055 South Grady Way, 6th Floor | Renton, WA 98057 | 425-430-7200
Email: franchisepermits@rentonwa.gov Website: rentonwa.gov
REVISION - FRANCHISE PERMIT APPLICATION
Published: 3/30/2017
TO THE APPLICANT: Only Current Issued Permits Qualify for a Revision. For any work related to an expired or
finaled permit, a new Franchise Permit Application shall be required. Submit an electronic copy of the plans
with the Revision Franchise Permit Application to franchisepermits@rentonwa.gov.
Permit #
Franchise Agency:
Franchise Job Number: Phone:
Contact Name: Email:
Job Site Address: Project Name:
Approved Description of Work:
Proposed Description of Work:
Reason for change of work:
“I certify that I am the owner or applicant’s 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
INSPECTIONS SHALL BE REQUESTED 24 HOURS PRIOR TO COMMENCEMENT OF ALL WORK BY CALLING THE
INSPECTION LINE AT 425-430-7203 OR BY GOING TO MYBUILDINGPERMIT.COM
Jobs are required to be called in for job start, re-inspection and project final. Re-inspection fees are billed at $75/hour.
All Pre-Construction meetings shall be scheduled at a maximum of 14 days prior to the job start date.
Plan Review/Development Engineering Date Approved as submitted
Pre-Construction Meeting required
Site Construction Inspector Date Approved with comments or redlines
Camera inspection of utilities required
Development Engineering Manager Date
MFP17003286
Qwest Corp d/b/a CenturyLink QC
N.259330
Amy Silbaugh
(360) 254-6920
amy.silbaugh@centurylink.com
540 Garden Ave N
ACCESS MH523, MH19, MH18, & MH553. PLACE 4 BORE PITS AND BORE FROM NE CORNER OF
PARK AVE N & N 6TH ST TO BIG SHOT PED, AND OVERSET UP1248 WITH BIG SHOT PED. PLACE NEW UP1248. TRENCH 10' FROM MH533 TO BORE PIT. REMOVE/REPLACE SIDEWALK RAMP & 5'X4' SIDEWALK PANEL .
DISTURBANCE OF HARD SURFACE. Required to pot hole and locate exis'ng u'lity depths prior to boring. Restora'on per City of Renton Standards .
Trench from MH18 to bore pit.
1/30/18Amy Silbaugh