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DEPARTNrrr OF PUBLIC WORKS Rec#o by <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APP CANT OFFICE USE ONLY <br /> U� JOB#1100s �DVE� <br /> bD_ fo 3 <br /> S .DATE DRIVEWAYS: <br /> Addms STREET <br /> QUAD SF- <br /> City,State-Zip Code TYPE -mow <br /> RMS 1e-t? Ss t.WA.) <br /> (Area Coda)Telephone OTE <br /> SITEINFORMATION <br /> Parcell Owners Nfima ` <br /> es ejmj Ale-, <br /> Site Address RIVfiWAY <br /> Q Q TYPE QUANTPPY. WIDTHS <br /> City State-Zip Coda GRICULTURE @ FRONTAGfi <br /> �09- loMMERCIAL <br /> (Area Code)Telaphow TRML R/W <br /> -IDIS <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTIl Ft. X WIDTH Ft <br /> 'Name <br /> Address The undwAp ed hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the A10erm' side of 62ooms M /4✓E• <br /> City,State-Zip Code app y o' it 00 r E -Tr of KE N f2Y <br /> 9M .by installing b J <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days- <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Conhwtoes License <br /> Aoccw%Per ApplFb mlkivcmyh ed frmtage <br />