HomeMy WebLinkAboutA_Francshise_Permit_Revision_Application_N.252054_180228_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
MFP17003544
Qwest Corp d/b/a CenturyLink
N.252054
Amy Silbaugh
253-372-5311
amy.silbaugh@centurylink.com
1201 Monster Rd SW
Access to MH125, HH1500, HH1400, HH1201 and Ped. Place aerial fiber along
5 poles from A0531404to A0561421. Trench 15' from Ped to pole A0561404.
CTL to place bore pit at HH1500 and at ped located next to pole A0561404
Bore approx +/- 370' between bore pits.
work needed in order to get services to our customer.
Amy Silbaugh
MFP17003544