2015-22 ROW Permit 11032015 City o#°Ye1m Permit No. �
PUBLIC WORDS
901 Rhoton Rd NW Application to Perform`Mork on
Yelm,WA 98597 Public Right of Way and/or Connect
Phone: 360-458-8406
to Utilities
FAX: 360-458-8417
PLICATION _
The undersigned hereby maces application to
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Location of work: 8947 Canal Rd.
I agree to perform the work in strict compliance with Yel �
p m IV[unicipal Code, Chapter the speciaQ
conditions enumerated herein and the attached conditions I have read and will adhere to the general provisions
applicable to permits contained on this form._
The Public, Works Department(560-468-8406) must be°contacted for ins ect on 2 4 hour-s before work
com e ces or this er it will e void.
The Underground Utilities Coordinating (1-800-424-5555)� 4 .w...... ..
�� � rdinating Council must be contacted two .2 working W.....w.
�, ( ) ing days
before roceedmg with any excavation associated with this permit.
Name. Puget Sound Ener m c/o Sara Wattenber
E C)X P ..tiVA 9fi06 m Phone (253),_306-2255 _ . - .
Pacific L-fi,�s
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P�rped °t� dallation 0 03/15 Duration 1 day ..-- ---Date° Are
m�PERMIT.REQUIREMENTS
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For Official Use Qnly
Fee Received$ l �......�mmmm. Apply anon vale
Issued
11
Receipt Number
Signature:
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Permission City
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To e Co Meted y
is hereby granted to perform the above described work subject to the general provisions contained
on this form, and the follow' special conditions: w y
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A bond in the amount of is required to insure compliance with the above
conditions, refundable upon satisfactory completion of work.
. _ - -
No work shall be done under this permit until the party or parties to whom it is granted shall have
communicated with and received instructions from:
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First Inspection inspector Final Project Date:
Date: Completion A°proyai:
Revised 03/09/2011
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