2014-16D ROW Permit 10272014 c�l' )'6m P e r i i ti-r. 2014-16
90 lkhotm Ed NV" At;plic�ltiiau to Pufcorm Worla on,
Public Right ofWay artd/(ir Connect
11 hone; to Utilifics
A iutl.A`k,-SA?
APPLICATION
'The "11,11,711.7 1 07
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Location of work:
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I agr" to perform the work in strict compliance vylth Yelm N17'inicipal Code, Ch-apter. ,__ "d
__,the Speci,
conditions emUmerated herein and the attached conditions I have read and will adhere to the general provisions
ajp contained on this form,
The Public 'Works Department(360-458-8-106) must be contacted for insnection 24 hours before worl:
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i The Underuround Utilities Coordinating Council (1-800-424-55-55) must be contacted two (2) working days
Lb P_F6 re R, (_,e t'�di II w i t h.aui y x cm,n assoc at e d with t h i s PO MI
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A 1W I
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Proposed starting d.qLc of installation: 5t�i L i o r
Daw, Si
N A T
VE RM 11 O-QUIRENFENTS
For Official Use On l),
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ce Rcceived S AppNeation /�,Pprovfl art rtstttut:: kre VM k�y
c6pt Number
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Permission is hereby granted to per the above described wo.ksubject to the acn(�Yal provisions contained
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oil this Furan, and tile C6,110wing s),,��cial conditions�
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A borid in dw-amount of is required to insure cornpliance with the above
conditions, refundable U[)+AI cr a ll4trnn of work
A,W -vvork sh'al i be dune u nuer th is pernilt an.til the Party or❑,mar�;es io whom It IS oranted Shall[lave
cornrnurw at:.d With LINd 1',X.6Vtd inSVLIIC.tion:S from,
'Firs, Inspection Inspectof Finaf Prcjca ale
Rz V i�cd 0.J``9. �20 I