2015-13 ROW Permit 05132015 01/11/201.3 PRY 9; Oq FAX 360459841,7 CiLyof;Yelm. Puk)lio Wox:kq 0004/004
t City Ol'yelm PCrrnit No, 2-0
PUBLIC WORKS
901 Rhaton Rd NIM Application to Perform Work on
Yelm,WA 98597 Public Right of Way and/or Connect
Phone- 360-458-8406 to Utilities
FAX: 360-458-8417
APPLICATION
The undcrsigiied hercby rnmes application to
J 7 —U,
............ .
7
g� Oz
-L-mat,i,oli or work
-
.............
1cc to perform the work in strict compliance with Yelm Municipal Code, hapt er the special
Conditions enumerated herein and the attached conditions I have read and will adhere to the general provisions
-Mpfic;a§I omahl"I on this form.
The Public Works Department(360-458-8,106)Lisu�%t t1v coutacteil for ins section 24 hours before NvoEls
com.luclices or th Utilities t will be void.
The Underground Utilities Coordina7g Council (1-800-424-5555)must be contacted two(2)working days
(jrq_proc"dingwith any excavation associated with this
Name:
Addrcss.
,b--S,b 7 J TUY
starting date of Instal lation: DuraflW T-a
Date: Signature.
Fqr'qTcial Vse 0 ly
T e e",-R,c-c-v,i ved$
Application Appriald4
cceipt Number
Signature.
—---- -----------
To Be Comple te!!Jiy�c
_FWril'TSTLOn'is hereby granted to perform the above described work subject to the general provisions contained
on this Form, and tlyefollowiqg_ p cial conditions:
............................
------------
.. ..............
in the amount of is required to insure compliance with the above
conditions, refundable n i oly C I tion of work
Ido work shall be done under this permit until the party or parties Lo ",hom it is granted shall have
co
aiLi�riicated with and received instructions from
Rtm'iarf S,
----------------------- ------ -----------
First inspection Inspector Final Prod tl
Date Comgteti A Etqvac
Rovisk,d 03/09/20H1
r ^w
a ..
e
� w
6tl?� �i�.i�y ir✓ ^• �a w+' w ' rte„ ^✓"
r �
�a
a1
i
aW
`u�
y`\s d S
i
X
uf
I
" :.
p
w
r�
41 �kp
04 r
It 4k.
tw n
�o
P�
0)3t N
E
> g ,
47 in o
1 'D�•`,,papd�� � � 1� o�-q W
d'.a RS
O
�Q � �°oZ� h V N N M
jc
h N
q,. o,In o
uj M
� � N
2_ O o In o
N h P W
�7
v�i7
O
OP. 0
LU o*
Z
l
fit" ''�°��°�,'� p/��,, t.�' a�°�MP✓
r
w E
N OJ
C cy ?
11 lo
m °
f E.E m c d z
w ° nom —° mn t7 0 <�
!Lm iw 3 -° 3 =¢
a U
f0 N tl1 M V w F- r-