2014-09B ROW Permit 05132014 01/1L,/2013 FRI 9 0S VAX 36045BJ417 CityofYelm PuW.ic Works
City or Yank Permit No.
PUBLIC WORKS
901 Rhoton Rd MV Application to Perform Work on
Yelin,WA 98597 Public Mght of Way and/or Connect
Phone. 360458-8406 to Utilities
FAX: 360-458-8417
APPLICATION
herebyrn akes appi i cation to:
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Mi Location of work:
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Tig'i ice to p-e-r—forin-t-h-e-w-o"r k-i-n--st R'et c-o'n—ip Rance a—nc e'-w i—th''Y'"e-Ir i i—M L i n'-ic-ip-a I-Co"d-e-,"-C"'11,,1 1—e� ............-'""-t I 1-e i-1,I
conditions enumerated herein and the attached conditions I have read and will adhere to the general provisions
al)LAicable to 1.xtinits contained on this fmrn.
The Public Works Department(360-453-8406)qiusthecanLcted..for rats i,egtioii241iatirl before_ivortt
Commences or this.permit.will be
The Underground Utilities Coordinating Council (1-800-424-5555) must be contacted two(2)working days
before P(ding N Ith 2my C"Aavation associated with this pqrnflt.
Nan,,
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Ad(h
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Proposed starting datc of instal lation Duraton:
SAM'-_........
-5 signature.- n
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Date: nature:
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11r,RMIT RYJ( M ht'
CN1ENT.S
Foi-Official Use Only
t cc Issued
C T�ccc►vvd S Application Approval
Rcccipt Number
1'o Be
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-i3e i��1' s-i o n"i's' h-e,-'r'e'b'y'.....granted to pe-r-f-b-i-m the above described work subject to the general provisions contained"]
on this farm,and the EoQq�wi
�tjg_sj3ecial conditions:
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bond in the amount of is required to insure compliance with the above
conditions,refundabic
pon of work,
..............................................................
N(.-�work shaii be done undi.,r chis pertink witil the pa�ly or parties (o whom R.isarante(i shall have
unicated v6th aud, mceived if.oStrucflons from:
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