Public Works Right of Way Street Work Permit Request

Public Works Street R-O-W Permit Request

Location: 120 Ramsdell St, Fircrest, WA 98466 ∙ Contact: (253) 564-8900 Email: PublicWorks@cityoffircrest.net
Applicant*

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Contractor Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contractor
UBI #
Phone Number
Please enter a valid phone number.
Email
example@example.com
Business License
Contractor License
Job # (if applicable)
Project Location Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Location of Work:
DESCRIPTION OF WORK: *
Will You be Cutting into the Street and/or Right-of-Way?*
If Yes - Approx. Length of Excavation
PURPOSE*

NewMaintenanceRepairReplace
TYPE OF SERVICE*

WaterSewerStormwaterDriveway/Driveway ApproachSidewalk/Curb/GutterGasElectricityTelephoneOther
Please upload your document

DETAILED SITE PLAN- Showing existing sidewalk(s), curb(s), gutter(s), Planter Strip(s), Property Lines and Right of Way lines & PHOTOGRAPHS/DRAWINGS - showing location(s) of proposed work in all directions.
Cancelof
Did you include a Detailed Site Plan?*
Did you include a PHOTOGRAPH(s)/DRAWING(s)?*
Did you include a Traffic Plan (if required)*

YesNoN/A
Signature*

Clear
Date

MonthDayYear
Date
For Staff Use Only:

Approved/Denied: __________________________ Date:___________________

Public Works Department

Application filed on _________ 2020 By________________________________

Street Work Permit Intake Fee $72.50
Plan Check Fee (First 150 ft.)$167.25 Additional ft. ($0.46/ft)
Inspection Fee – UTIL (First 150 ft.) $178.50 Additional ft. ($0.88/ft)

Received by ____________Fees Paid_________________Receipt#____________

Work Completed & Inspected By _________ Date of Final Inspection __________
Should be Empty:

Public Works Street R-O-W Permit Request