Northlake Wood-CS050517
T H E - C I T Y . 0 F
CC: Applicant ~- .~ --~..A...~ w .-- Page I of 4
Pu ,ic works COFFELL
FILE COPY
Orig. to Project File
RIGHT-OF-WAY pER IT APPLICATION
Permit valid for 90 calendar days from date of approva!
Submit permit al~[flication to the En~ineerin~ Dept., Town Center, 255 Parkwa~ Blvd.
Date of Submittal: ~/'~' O''5~' Applicant's Job # / Work Order #
PERMIT FEE: $100.00
(No charge to Utility Companies with approved Franchise/ROW Use ,4greemenO
License Agreement Approved (date)__/ / Certificated Telecom Provider? Y N
[] Plans provided and approved
(Erosion Control/safety fences must be installed prior to beginning
Project Name / Location: /~,$,~4a~ ~?)/ C~4 ~6~.. ~l~,~/~,q c-ff/~a
General Contractor:
Permit issued to Company / Representative: .2)~4
Address: /~/ff' ,/-,~ffOtn/ (~'AA°~'og6.t4~g~/ 7~.
Telephone #: q 2- 72 3 ' 870 Emergency Teleplaone #:
uCOmpauy Represented:
Electric Delivery Co. [] Atmos Energy (formerly TXU Gas) [] Verizon [] SBC [] ComCast Cable
[] AT&T Local Services [] Grande Corn (formerly CoServ) [] CoServ Electric/Gas [] Other
~ If "Other" is checked, please note that franchise or right-of-way use agreements will be required and need
Council approval prior to beginning work. Permit cannot be approved until that time.
General Description of Work (provide 3 sets of plans):
Estimated Start Date ~/--~Y-'~' g~ ~- Estimated Completion Date*
* Completion requires submittal of Completion Verification Notice (see page 4)
~ Was contact made with City and/or utility companies to locate existing utilities?
if NO, Reason: YES [.~ NO []
3> Is removal of existing streets, alleys, or sidewalks necessary? YES [] 1NO
if YES, must have City inspection prior to concrele replacemettt