HomeMy WebLinkAboutA_Franchise_Permit_Application_N.274299_170804_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
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@rentonwa.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:
Franchise Job Number: Phone:
Contact Name: Email:
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:
Contractor Name: Phone:
State Contractors License #: City of Renton Business License #:
“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
Qwest Corp d/b/a Centurylink
N.274299
Corben Etteldorf
253-209-0849
Corben.Etteldorf@Centurylink.com
800 SW 27th St, Renton, WA 98057
Access MH369, MH696, MH697, MH698, MH699 & PED800. No disturbance of surface.
North Sky Communications 360-254-6920
NORTHSC857Q4 BL.028638
8/04/2017
MFP17003779
Holly Powers