Fillable CITY OF FEDERAL WAY – CITY CLERK’S OFFICE

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CITY OF FEDERAL WAY – CITY CLERK’S OFFICE

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K:\FIN\BL\Business License\RIGHT OF WAY PERMIT BL.doc
Right-of-Way Activity Permit
DATE OF PROPOSED ACTIVITY: ____________________________________________________
NAME OF PROPOSED ACTIVITY:________________________________________________________________
NAME OF APPLICANT: ______________________________________________________________________
PHYSICAL ADDRESS:
MAILING ADDRESS:
______________________________________________________________________
Street City State Zip
Same as physical address (if not, please indicate below)
______________________________________________________________________
Street City State Zip
PHONE NUMBER: ________________________________________________________________
ALTERNATE CONTACT PERSON: NAME: ______
____________________________Ph # _____________________
TYPE OF ACTIVITY: Parade Run Walk Procession March Race
Block Party Demonstration Exhibition Organized Rally
Other (specify) _______________________________________________________
PLEASE ATTACH A MAP OF DESIRED ROUTE/ACTIVITY LOCATION.
Desired route, including assembling points:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Traffic and activity control plan:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Are traffic/pedestrian barricades needed?
Yes
No. If YES, barricade placement locations:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Number of Persons: ____________ Vehicles: __________ Animals: ____________
Proposed Time Of Activity: Start Time: ___________ End Time: ___________
Page 1 of 2
EMAIL ADDRESS:
_____________________________________________________
REGISTRATION # __________-________________
K:\FIN\BL\Business License\RIGHT OF WAY PERMIT BL.doc
Name of Insurance company and policy number:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
CERTIFICATE HOLDER: City of Federal Way, 33325 8
th
Ave S, Federal Way, WA 98003
PLEASE ATTACH ADDITIONAL PAGES OR MAPS IF MORE SPACE IS NEEDED
Does applicant have previous experience with activity: Yes No
ADDRESS: __________________________________________________________________
PHONE: __________________________________________________________________
Signature of Applicant
Date of Application
For City Use Only
Police Review:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Approved Denied By: ________________________________ Title: ____________________________
Fire Review:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Approved Denied By: _____________________________ Title: ________________________________
Public Works Review:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Approved Denied By: _____________________________ Title: ________________________________
Page 2 of 2
E-SIGNATURE IS NOT ACCEPTED
Federal Way Co
mmunity Center:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Approved Denied By: _____________________________ Title: ________________________________
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CITY OF FEDERAL WAY CITY CLERKS OFFICE

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Completed 15 July 2020

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