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ROW2013-00073 APPLICATION FOR WORK IN RIGHT -OF -WAY (ROW) PERMIT Development Engineering TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 624 -0752 FOR STAFF USE ONLY General Information: WR 718412 Right -of -Wa Property Address /Location(s): 9350 SW LEHMAN ST TIGARD SEG ID Case No.: ; 1 , • — •■• • w Application Accepted: ( 6 I By: *Applicant's Name: Portland General Electric Application Reviewed: tS By: Address: 9480 SW Boeckman Rd Fee Due: I" f Pc City /State: Wilsonville OR Zip: 97070 Applicant Notified: Primary Contact: LORRAINE KATZ Receipt No.: Phone: (503) 570 -4407 Fax: (503) 570 -4420 8 ' /S. /3 IS nd „-)20 REQUIRED SUBMITTAL INF"RMATION Contractor's Name: NIA CCB# Expiration: Address: Submit a scaled sketch of the proposed work to be done City /State: Zip: Phone: Fax: Professional Engineered Plans are required for: Plans By: • Street Widening Address: Subdivision Infrastructure • City /State: Zip: • Main utility line extension: Phone: Fax: Description of work: INSTALL UG SERVICE TO 8 LOTS Estimated value of work (within the public right -of -way): $ Is work related to a LAND -USE DECISION? YES NO I I If so, please specify (MLP, SDR, SUB, etc.) case #: Is the work related to a BUILDING PERMIT? YES I NO . If so, please specify (BUILDING PERMIT) case #: *NOTE: Person specified as "Applicant" shall be designated "Permitee" and shall provide financial assurance for the work. 20 n4- Zate-vi.Loei/1 v, P F l cWSersbmlapptlataUOCalVnicrosofl \windows\temporary internet files \content. outlook \u4j0xnh2 \wr 718412 city of tgard permit.docx SUBDIVISION LEGEND Cl 1-26C ! C1 1-26D NEVI PGE 'Arum's TO BP INSTALLED fUNIZSA 131.W.S4 SPECIFIS01 I— lit, tt• Lier" MI= W.A. n aft. we 21 si mec C••••••••••••• =Ix= :2: o•-•=7"../ A 41 3 . ":•:"••••""7 21 ": ...— ,e---- / we./ • • ....... a. ..., won. •=7 • ....... o........ own. gi MLATOMZIK• 1 I / Fa [WM I ---------' ... .. No I ••= ,,....=',..... may a. ma a a ass a a. NW WORM 6 MEWS IV Mr*. PA POI NW Awl• PLO ..,.. .0 mirk sPuo• ."506 SO 27001 t - - - .- .,........ ,...,,.• 4 c.. 14 ft- 01111 a I swop SE MX EPS OF se C. 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