2014-08 ROW Permit 04252014 rRI �9 0 FAX ?6045834t,? CU LY0,EVelm Public Works
2014-08
City Of Win Permit No,
PUBLIC:WORKS
901 Rhoton Rd nV Appticatioti to Perform Work on
Yelm,WA 98597 Public Right of Way and/or Connect
Phone: 360-458-8406 to Utilities
FAX: 360-453-8417
APPLICATION
The undersigned hereby makes application to:
Y,
Location or Y'd
-- ----------------
I agree to perform the work in strict compliance with Yelm Municipal Code,Chapter _, special
conditions enumerated herein and the attached conditions I have read and will adhere to the gener provisions
applicable t �mirrits contained on this form.
The Public Works Department(360-458-8406) niust be contacted for ins lwc(12it 24 Itomwrs before vyotk
commences or this pernmit will be void.
The Underground Utilities Coordinating Council (1-800-4211-5555) must be contacted two(2)working days
be fore ,V th a �x,,vv t' ri associated with this t.
Name
'ess: Phoric:
Pro sed
Dater
Fai-Official Use Only-__
Fee Received Ap--p1-c`atio-n,Approval
he V/� my
I; I. Number
TO Be-CnT-Pitt
Perrnissson is hemebtr r a n't-e d to perform the abov-e"descri bed work subject to the general provisions contained
on this form, and the_f L) lI r)±,LnjLj Lci iaj conditions,
........-—---------.........
.......... ............ ......
................--,–............... ------------- ................–--------.. ........ ...........
A bond in the aniount or is required it)insure compliance with thcabove
cond refundabli .�I?a-��j . 'w y,c)m lefion of work,
�P-r,
. . .............
%V011'k shall lbe.done uncler perrn4 untfl tht party 0 1 [�anfleS jt j.,; ('iratlt[,V(�, Sjlj«fl I 11a%,e
re�,eived frorn:
.......... .........
--—----–--------
st. lnspeclk.�r�
fl?muG Corn
0r/11,'2013 PRY. 9 0 VAX 36U4588411A C-%' Ly0f,eLTn Publ,ic Works i00 4/0
or r City Of Y elm Permit No.
PUBLIC WORKS
901 Rhoton Rd MV Application to Perform Work oil
Yelin,WA 98597 Public Mght of Way and/or Connect
Plione: 360-458-8406 to Utilities
FAX: 360-458-8417
=11 tt ryq
o n o f vn—ik
�agree Co perform the work in strict compliance with Yelm unicipal Code,Chapter the speci�al
conditions enumerated herein and the attached conditions I have read and will adhere to the general provisions
«r lrl�rcable tat rntits contained on this form..............
"The Public Works Department(360-458-8406)must be contacted for inspection 24 hours before worIc
The Underground Utilities Coordinating Council (l-800-424-5555) must be contaded two(2)working days
Nbeforerr apt ,ceding with lan .. kcavation associated with this
' —P ......
051
Propo RL
.�Sd�tartina date of it i(Mlaii0n, -4G 114 Duratiow
Date:
i
[,S gn,ature:,
1,1v n I INTENTS
For Official Use Oniy
Issued
.
...................--------------- . ...
lcu, Received 8 Application Approval
c,ccipt tuntm.
To Be COM let�itBy City
Permission is hereby granted to perfiii-in the above described %vork subject to the general provisions contained
on this forni,and [lie rollowitip special conditions:
............................. ...... 111-
--A—b—oi7dlii the amount.....o"T.............. is required to insure compliance with tile above
...........................
conditicni,s, refundable.uL�,'.jii orwork,
--1---111111............---111111-1 111111-1111111111 1-11111-1—1-
uar woii k shall lb e done,under dAs perrn 4 until the pally or�,inrues to wboian, it is granted sho.H ho.l,e
and rerxi'�'ed instructkms fr"'.nn�
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