2014-02 ROW Permit 01212014 1/_U13 PRT F A:i C I'tr 'J F Y t-1 L11 P L I'L)L j-
City of Yelm
PUBLIC WORKS
901 Rhoton Rd NNAI 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
"HIC Undel-sitlocd hereby makes apj4ication to .......
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fallrec to perform the work in strict co "Y' e I M, tini,cipadCode Chapter e -,e 41 1
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Conditions enunwrated herein and the attached conditions I have read and vvill adhere to the general provisions
_�Pj�!icable tolLqrnits contained on this fol-111,
..................... ........ . ......
-1-110 ic Works Department (360-458-8406) inust be contacte(l, ill I
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The Underground Utfles Coordina6ng Council (1-800-424-5555t MUSt be contacted tvvo(2) working days
before fproceedinv,\011 anLexcavation 1sso�i,ated wiflfr 1his 1�x-rrnit,,m. Yn),
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Ao�y Signature:
PEI Fur Official Ilse Only
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11crmission is hereby granted to perform the a�ove dell
escribed work subject to the general provisions contained
11 this 6orni, and the follo ca conditions;
A bond iii the anjoijilt c)f is requ ired to insure compliance with the above
conditiom,,, t(�hmdablC U[�911 completion of work.
......... ......
No v,,Oi-k6iiiiilbcci(.)riQ (jrlci(,i thi.spelinituntil thv party or parties to whom itisoranwd shall have
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VOM1111.11licated with and received instructions froliv
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