HomeMy WebLinkAboutapplication R yaht-of-Way P crmit A n2lication
For submittal checklist, see below.
*denotes required fields
P Ioject Information
*Project Name: ICO M(AST-JB00023839
*Description of Project:
STARTING WITH VAULT 1, BO RE AND PULL 1,040' NW
TO VAULT 3. CO NTINUE WORK O NTO PRIVATE
PRO PERTY.
Engineers Estimated C cst of C mstruction; $ 15,000
C mtact Information
Owmr Information
*Owxer Name: IJANE BAIN
*Office No.: -
*Email Address: JANE BAIN@CABLE.COIN
*C dl No.: 9713525392
*Mailing Address: 11701 JO H NF KENNED YI
*C ty: PH LAD B-PH A
*State: PA
*Zip: 19108
E igineer Information
Engineer Name:
O ffice No.:
Email Address:
Cd1No.:
Mailing Address:
C ty:
State:
Zip:
Professional License
Number:
Expiration D zte:
C mtractor Details
Primary C mtractor: ICABLECO M- Leah Ihleni
O ffice No.:
Email Address: ISNO H O KH PERM ITTIN
Cd1No.:
Mailing Address: 11429 AVE D #339
Cty: ISNOHOMiH
State: WA
Zip: 198290
L&I C mtractor CABLEL*971D P
License Number:
Expiration D fie: 2027-08-21
A cknowledgement
I, hereby certify that I have read and examined this application, Cty of Arlington Municipal C ale, Standard Plan &
Specifications. Performance of the proposed work shall follow all applicable laws and regulations. The owner/applicant
shall assume full and complete responsibility for said work and shall be responsible for the acquisition and compliance
of all applicable permits and/or authorizations which may include,but not limited to, R#ht of Way Permit, WSDW
Hydraulic Project Approval(HPA), WSD OENotice of Intent(NOS National Pollutant Dscharge Elimination System
(NPDES),Army Corp. of Engineers Permits, the requirements of the Endangered Species Act, and the Forest Practices
Application (FPA).
*P rint Name: 1colin Broenner *Date: 2026-02-11
Submittal C becklist
Canplete package constitutes all items. Only complete submittals wf71 be accepted.
Electronic files shall be PD Fand submitted through this portal, email or downloadable link to file server.
• C instruction Plans; refer to D esign R Muirements and C lapter 1 of the C ty of Arlington's D esign and C instruction
Standards and Specifications Manual for required sheets.
• Traffic C introl Plan.
• R cad Closure R equest.
• Temporary Erosion & Sediment C introl (TESC)Plan if new or replaced hard surfacing is being constructed.
• C ertificate of Insurance with the C ty of Arlington named as Additional Insured.
P ermit fee and any assurarnce device (B and or Assignment of Funds) due at time of permit
issuance. An invoice with link for payment will be sent to the applicant email address once
permit is reviewed and approved.