2015-15 ROW Permit 07142015 t City of Yelm Permit No.
PUBLIC WORKS
Rhoton Rd NW Application Perform or on
Ye lm, A 98597 Public Right of Way and/or Connect
Phone: 360-458-8406 to Utilities
FAX: 360-458-8417
APPLICATION
The undersigned herebymakes application to:
,[ U �,w-W:- "l a�.�..A�..��.... ... �.�..l i �a�ti y.�.�_�t� .��'� f P ,�,I mm��"C�,.« �� �p ,� '�t"� ` •A ,.9p.
"work
f oca lion of
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I agree to perform the work in strict compliance with Yelj Municipal Code, Chapter— mmm _.._, the special
conditions enumerated herein and the attached conditions I have read and will adhere to the general provisions
a licable to_pei°mits contained on this form_._
The Public Works Department(360-458-8406)must be contacted for inspection 24 hours before work
commences or this Dermit will be void. _ _
The Underground Utilities Coordinating Council(1-800-424-5555)must be contacted two(2)working days
associated,,wit this permit.
L I ap��"!:.�:.—�I`�_°
I��.o�•a��w.���1 ;f � �
1 �pose"d � g nature
i S : _.._.... ...__....
PERMIT l .li t
For Official Use nl
Fee " � Issued � � ..
. _. .__.................._.. ........_
Fee Received Application Ap r•°
ecei t Number ° Si. nature:
To Be Completed BBB City
Permission s
o this form, n
the ollowis ec aconditions:
l
hereby t®p above described work subject to the ge sions,c tained
neral rovi
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 or parties to whom it is granted shall have
communicated with and received instructions from:
_.. _.-- ------ w.. .....- ._ ...-_m..,_�.....,,... �....._ .
Remarks:
._. .......................... _v......__W _......
First ecte
s
p on Inspector Final Project ate:
Date:
Completion
evised 03/09/2011
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