HomeMy WebLinkAboutP_Map_109106594_V1_170824Date of Request
Job number:
Job address:
Project mgr:
PM email:
PERMIT REQUEST FORM
08/17/17
109106594
327 S 15TH ST C
Kelsey Savage
Kelsey.Savage@pse.com
Estimated job start date:
Estimated job completion date:
Description of work to be performed:
08/15/17
08/15/17
Renton
Zia: 98055
PM contact #: (253) 617-6028
Pavement cut? Yes �No
If yes, Dimensions of Cut: Length 9
How many cuts? 1
Surface Type
ASPHALT
Require trenching? Yes
If yes, Dimensions of trench:
Method of installation:
Traffic impact:
Width s
�No
Length Width
Road closed Yes � No
Lane closed MT ❑ No
Shoulder closed ❑Yes F No
Sidewalk closed Dyes 0 No
Emergency Contact: JON HENDERSON
Cell Number: (360) 490-7167
Depth
How Many? 1 Direction? East
PUGEr
OUND
ENERGY
PAVING
REQUEST
ADDRESS: ;rig ca�r
TICKET:
5065516
PERMIT: jQq1 0 59H
SHEET:
CHECK: CITY: REQUESTEY:
Eq INSIDE ❑ OUTSIDE Z NT Q� ❑ POTELCO INFRASOURCE ❑ PSE
DRAW LOCATION OF CUT AND NUMBER IT ACCORDINGLY:
C1
77
MATCH N
FROM DRAWING
ABOVE
TYPE
(SEE KEY
BELOW)
SIZE
(CALLED
OUT)
DEPTH
IN INCHES
LOCATION
SIZE
(ACTUAL
INSTALLED)
Example t
A
2 X 8
8825'
N CIL Test St
AA fo complete
qX�
V&7
O SIn
SAP ORDER NUMBER: � D "1 IObS CI `�1C
LOCATE NUMBER:
SAP NOTIFICATION NUMBER:
PM/PERSON RESPONSIBLE: GGII
FORM FILLED OUT BY: Drj JD/0)V
DATE HOLE CLOSED: 1
DATE AA RECEIVED:
AA LOCATE NUMBER:
YES NO
KEY
TRAFFIC CONTROL ❑ ❑ C = - CONCRETE IN STREET OR ALLEY4NCLuoiNocuaBnNDGurrER)
POLICE OFFICER ❑ ❑ C/WC = CONCRETE WHEEL CHAIR RAMP
PLATE OVER HOLE ❑ ❑ C/SW = CONCRETE SIDEWALK, DRIVEWAY APPROACH
NO PARKS
QNCLUDING CURB AND GUTTER)
❑ ❑
SHALLOW UTILITIES (LESS THAN lad ❑ ❑ C/G = CONCRETE CURB OR GUTTER
IN RIGHT OF WAY ❑ ❑ A = ASPHALT
PRIVATE PROPERTY ❑ ❑ A/C = ASPHALT OVER CONCRETE
UNDER TROLLEY LINES ❑ ❑ G/O ASPHALT GRIND AND OVERLAY
FINAL TICKET FOR THIS JOB ❑ ❑ V = VALVE (RAISE VALVE AND REPAVE)
EXTRAORDINARY NCC (OFFICE USE) ❑ ❑ 8 = BRICK(COBBLESTONE)
M = MISC (STRIPE,
GRADING, ETC.)
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