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Right-of-Way UseCity of Auburn <br />ApplicationEngineering Division <br />Permit #: <br />Name of Organization: <br />Officer/Agent/Person Requesting Permit & Title: <br />Address:City/State/Zip: <br />Daytime Phone:Email: <br />Desired Use of Right-of-Way (if needed please attach a letter to describe more detail regarding the request): <br />Location of Right-of-Way: <br />Date(s) Requested: <br />The Department requires the name and daytime telephone number of three (3) responsible persons, any of which <br />can be contacted at any time during the life of the permit in the event the need arises. <br />Name:Daytime Phone:( ) <br />Name:Daytime Phone:( ) <br />Name:Daytime Phone:( ) <br />Date: <br />Signature of Applicant <br />Documents Required: <br />Permit Application Fee *Legal Description <br />Initialed Notice to ApplicantContractor's Additional Insured <br />Signed Hold Harmless AgreementBond <br />Certificate of InsuranceSigned Petition (Abutting Prop. Owners) <br />Traffic Control Plan <br />* Fee Schedule: <br />Type B$60.00 <br />Type C$100.001st year <br />$30.00each add'l year# of years ____ TOTAL __________ <br />Type D$100.00plus add'l estimated staff time @ $50/hour <br />Street Closure add'l to Type B or C$90.00 <br />Sidewalk Closure add'l to Type B or C$60.00 <br />Parking Closure add'l to Type B or C$60.00 <br />NOTES AND/OR CONDITIONS <br />1) This permit does not constitute approval or compliance with the rules, regulations, or requirements of any other <br /> jurisdiction, which may relate to the above project. <br />2) If this permit is to be recorded with the County Assessor's Office, please attach a legal description. <br />For all questions, contact Amber Mund at 253.804.3120 or email amund@auburnwa.gov <br />FE068 <br />