HomeMy WebLinkAboutA_Sartori Century Link ApplicationDEPARTMENT OF COMMUNITY 1011111000106
CITY OF
AND ECONOMIC DEVELOPMENT enton `�
Planning Division 11055 South Grady Way, 6th Floor I Renton, WA 98057 425-430-7200
Email: franchisepermits@rentonwa.gov Website: rentonwa.gov
FRANCHISE PERMIT APPLICATION
Published: 3/30/2017
TO THE APPLICANT: Submit an electronic copy of the plans with the Franchise Permit Application and the
Traffic Control Application to franchisepermits@rentonw .gov. 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.
Franchise Agency: Qwest Corporation dba CenturyLink QC
Franchise Job Number: Sartori School Project Phone:
206-345-4476
Contact Name: Alex Harb Email: Alex.Harb@Centurylink.com
Job Site Address: 315 Garden Ave North Project Name: Sartori Elementary School
Description of work: This is a schdule 73 OH to UG converfsion for the Sartori Elementary School
The contractor performing the work for CenturyLink will be Forma Construction.
Forma will be placing 550' of 1-4" conduits as shown on submitted plans.
Please check all that apply:
❑ New Construction ® Repair/Relocate ❑ Underground ❑ Overhead ❑ Sidewalk ❑ Street
® Open Trench ❑ Bore # of feet: 550'
Contractor Name: Forma Construction
Phone: 253-213-3682
State Contractors License #: FROMACC878OR City of Renton Business License #: BL000137
"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 CU_-�L t6a"L_& Date 7/21/2017
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 ►ire-consrrucrion meerings snap ae scneauiea or a maximum of 14 aays prior to me Jon start date.
Plan Review/Development Engineering Date
Site Construction Inspector
Development Engineering Manager
Date
Date
Approved as submitted
F Pre -Construction Meeting required
❑ Approved with comments or redlines
❑ Camera inspection of utilities required
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Page 1 Published: 3/30/2017