HomeMy WebLinkAboutAccess Connection M94-0053 - RAP Permit / Conditions - 8/11/1994 RECEIVED
ASK AUG 1 2 1994
Washington Stat�Jy�',� y[; District 3 Headquarters
Department of TraflS rf i1"I'T' 5720 Capitol Boulevard,Tumwater
P.O.Box 47440
Sid Morrison
Olympia,WA 98504-7440
Secretary of Transportation
August 11, 1994
(206)357-2600 '
David_ T. Evans Fax(206)357-2601
P.O. BOX
Un' A 98592
SR 1 CS 2304
Access tnection Permit M94-0053
3 L Mile Post 9.36 Right
Dear Mr. Evans:
Attached is your executed original Access Connection Permit allowing you to perform the indicated
work within the state highway right-of-way.
The bonding requirement of this permit is satisfied by a $2,000.00 "Assignment of Escrow"
account at the "Seafirst Bank", in Shelton, WA. The "Assignment of Escrow" will be held until
all work under that permit has been completed and approved by the Department.
Before beginning work on this approach, please contact both the Area Maintenance Superintendent
and the Utility Underground Locate Center to advise them of your planned work, starting date, and
location. The Area Maintenance Superintendent's phone number is on front of the Special
Provision page, and the Utility Underground Locate Center phone number is 1-800-424-5555.
No work is authorized within the state highway right-of-way until this notice is given.
Upon completion of work on this approach the Grantee will need to make a written request for
inspection and release of escrow as provided under Special Provision No. 22 to the Area
Maintenance Superintendent. It is your responsibility to provide any release of escrow forms
required by the "Seafirst Bank".
Sincerely
DALE C. SEVERSON, P.E.
Development Review Engineer
DCS
TI S
cc: .4rMason County - Planning
M. McGill
I
Washington State
Department of Transportation Access Connection Permit
F F— CEIV � 0 cs 2304 SR 106
Permit No. M94-0053 AUG 0 W4 District No. 3
8
Name and Address of Applicant: r, . ?=
David T. Evans
9381 Highway 106
P. O. Box 66
Union, WA 98592
The Applicant, hereinafter referred to as the "Grantee,"having applied for a permit to
construct, upgrade, use and maintain, within the state right-of-way a Type A, road
approach to serve a single family residence at Mile Post .36, right side, located in the
Northeast 1/4 of the Northeast 1/4 of Section 35, Township 22 North, Range 3 West,
W.M.,
on a portion of State Route No. 106 in Mason County, Washington,the Washington
State Department of Transportation or its designee, hereinafter referred to as the "Department," hereby orders that this
permit be granted, subject to the terms and provisions stated upon the reverse hereof and Exhibits attached hereto and by
this reference made a part hereof:
Exhibit "A"— Special Provisions for Highway Encroachments, Pages
1, 2, and 3
Exhibit"B". Right-of-way sheet and map showing access point. Page 1
Exhibit"C". Traffic Control Plans. Pages 1, &2
NOTE: No other access will be granted from the state route to this location.
This permit shall be void unless the construction herein
contemplated is started within 90 days of issuance and
completed within 120 days of issuance, unless otherwise
provided herein.
completion date: May 31, 1995
This permit is accepted and approved by the Grantee
subject to the terms and provisions as herein set forth.
GRANTEE— DEPARTMENT OF TRANSPORTATION
J `
By: 'r^< .Z By:
Title: LJ��
--, Title: Development Raveaw
Date: / Date of Issuance: 8 bl Z !.
/
DOT Form 224-005X(front)
7/92
General Provisions
1. The Grantee,its successors and assigns,agrees to protect the State of Washington,its officers and employees and save them harmless from all claims,
actions or damages of every kind and description which may accrue to or be suffered by any person,persons,or property by reason of the acts or
omissions of the Grantee,its assigns,agents,contractors,licensees,employees or any person whomsoever,in connection with Grantee's,its assigns',
agents',contractors';licensees'or employees'construction,installation,maintenance,operation,use oroccupancy of the right of way or in the exercise
of this permit. In case any suit or action is brought against the State of Washington,its officers and employees,arising out of or by reason of any of
the above causes,the Grantee,its successors or assigns will,upon notice of such action,defend the same at its sole cost and expense and satisfy
any judgement against the State of Washington,its officers,or employees: PROVIDED,that if the claims or damages are caused by or result from
the concurrent negligence of(a)the State of Washington's agents or employees and(b)the Grantee or Grantee's agents or employees,this indemnity
provision shall be valid and enforceable only to the extent of the negligence of the Grantee or the Grantee's agents or employees.
The Grantee,and on behalf of its assigns,agents,licensees,contractors and employees agrees to waive any claims for losses,expenses,damages
or lost revenues incurred by it or its agents, contractors, licensees,employees or customers in connection with Grantee's, its assigns', agents',
contractors',licensees'or employees'construction,installation,maintenance,operation,use or occupancy of the right of way or in the exercise of this
permit against the State of Washington,its agents or employees except the reasonable costs of repair to property resulting from the negligent injury
or damage to Grantee's property by the State of Washington,its agents,contractors or employees.
2. During the progress of the work,such barriers shall be erected and maintained as may be necessary or as may be directed for the protection of the
traveling,public;the barriers shall be properly lighted at night.
3. Except as herein authorized,no excavation shall be made or obstacle placed within the limits of the State highway in such a manner as to interfere
with the travel over said road.
4. If the work done under this permit interferes in any way with the drainage of the State highway,the Grantee shall wholly and at its own expense make
such provision as the Department may direct to take care of said drainage.
5. On completion of said work herein contemplated,all rubbish and debris shall be immediately removed and the roadway and roadside shall be left
neat and presentable and satisfactory to the Department.
6. The cost of construction or modification of a connection shall be,the responsibility of the Grantee,including the cost of modification of any connection
required as a result of changes in property site use in accordance with WAC 468-51-110.
7. The Department hereby reserves the right to order the change of location or the removal of any structure or structures authorized by this permit at any
time,said change or removal to be made at the sole expense of the party or parties to whom this permit is issued,or their successors and assigns.
B. Existing permitted connections impacted by the Department's work program and which, in the consideration of the Department, necessitate
modification,relocation,or replacement in order to meet current Department connection location,quantity,spacing,and design standards,shall be
modified,relocated,or replaced in kind by the Department at no cost to the Grantee. The cost of further enhancements or modification to the altered,
relocated,or replaced connections desired by the Grantee shall be the responsibility of the Grantee.
9. If any changes are made or proposed in the land use,intensity of development,type of traffic,or traffic flow of the property served by this connection
permit,the grantee is required to contact the Department to determine if further analysis is needed to determine if the change is significant and would
require a new permit and modifications to the connection.
10. All such changes, reconstruction, or relocation by the Grantee shall be done in such manner as will cause the least interference with any of the
Department's work,and the Department shall in no wise be held liable for any damage to the Grantee by reason of any such work by the Department,
its agents or representatives,or by the exercise of any rights by the Department upon roads,streets,public places,or structures in question.
11. This permit or privilege shall not be deemed orheld to be an exclusive one and shall not prohibitthe Departmentfrom granting other permits or franchise
rights of like or other nature to other public or private companies or individuals,nor shall it prevent the Department from using any of its roads,streets,
or public places,or affect its right to full supervision and control over all or any part of them,none of which is hereby surrendered.
12. The Department may revoke.amend,orcancel this permitoranyof the provisions thereof at anytime bygivingwritten notice to the Grantee.The Grantee
shall immediately remove all facilities from the right of way.Any facilities remaining upon the right of way 30 days after written notice of cancellation
shall be removed by the Department at the expense of the Grantee.
13. It is the responsibility of the applicant or Grantee to obtain anyother local permits orother agency approvals that may be required,including satisfaction
of all environmental regulations. It is also the responsibility of the Grantee to acquire any property rights necessary to provide continuity from the
applicant's property to the Department's right-of-way if the Grantee's property does not abut the right of way.
14 The party or parties to whom this permit is issued shall maintain at its or their sole expense the structure or object for which this permit is granted in
a condition satisfactory to the Department.
15. Any breach of any of the conditions and requirements herein made,or failure on the part of the Grantee of this permit to proceed with due diligence
and in good faith after its acceptance,with construction work hereunder,shall subject this permit to cancellation as herein provided.
16. This permit is subject to all applicable provisions of 468-51 WAC, Chapter 47.50 RCW, Chapter 47.32 RCW, and/or Chapter 47.44 RCW and
amendments thereto.
DOT Form 224-005X(back)
7/92
Washington State Special Provisions for
�
VI/ Department of Transportation Highway Encroachments
Permit No. M94-0053
Applicable provisions are denoted by (X)
® 1. No work provided for herein shall be performed until the Grantee is authorized by the following Department representative:
M. McGill
Area Maintenance Superintendent
8293 Spring Creek Rd. SE, Port Orchard, WA 98366-9613
Phone: (206) 895-4753
® 2. Prior to the beginning of construction,a preconstruction conference shall be held at which the Department and the Grantee
and Grantee's engineer, contractor, and inspector shall be present.
2 3. Should the Grantee choose to perform the work outlined herein with other than its own forces,a representative of the Grantee
shall be present at all times unless otherwise agreed to by the District representative.All contact between the Department
and the Grantee's contractor shall be through the representative of the Grantee.Where the Grantee chooses to perform the
work with its own forces,it may elect to appoint one of its own employees engaged in the construction as its representative.
Failure to comply with this provision shall be grounds for restricting any further work by the Grantee within the State right of
way until said requirement is met.The Grantee, at its own expense, shall adequately police and supervise all work on the
above described project by itself,its contractor,subcontractor,agent,and others,so as not to endanger or injure any person
or property.
® 4. A copy of the permit must be on the job site and protected from the elements at all times during any of the construction
authorized by said permit.
R? 5. This permit does not give the Grantee or any agent or contractor of the Grantee any rights to cut, spray, retard, remove,
destroy,damage,disfigure or in any way modify the physical condition of any vegetative material located on the highway right
of way, except by written permission from the Department or for purposes as described by No. 6 if denoted below. All
restoration shall be done to the satisfaction of the Department at the sole expense of the Grantee.
E9 6. If necessary to increase sight distance, brush shall be removed from both sides of the access connection and stumps shall
be removed. The indiscriminate cutting of merchantable timber or disfiguring of any feature of scenic value shall not be
permitted.
7. The access connection(s)shall be constructed in accordance with the attached
Sufficient length of -inch diameter culvert pipe shall be placed in ditch and laid to a true line and grade.The
access connection(s)shall be surfaced to the limits as shown on the plan with a 6-inch minimum compacted depth of gravel
base material and a 3-inch compacted depth of crushed surfacing top course.Asphalt paving will not be required. Finished
grade of the access connection shall be in accordance with the profile control as shown on the attached plan. Directing of
surface water from private property to Department right of way will not be permitted, unless otherwise approved by the
Department.
Y 8. The access connection(s)shall be constructed in accordance with the attached Type °A° Plate
Sufficient length of 18 -inch diameter culvert pipe shall be placed in ditch and laid to a true line and grade.The
access connection(s)shall be surfaced to the limits as shown on the plan with a 6-inch minimum compacted depth of gravel
base material a 3-inch minimum compacted depth of crushed surfacing top course and paved with a 3-inch minimum
compacted depth of Asphaltic Concrete Class B unless otherwise specified by the Department. Any existing oil mat on
shoulder or roadway shall be removed and new pavement laid to a butt joint with existing pavement. Finished grade of new
pavement shall be in accordance with the profile control as shown on attached plan. Directing of surface water from private
property onto Department right of way will not be permitted, unless otherwise approved by the Department.
W 9. All buildings and appurtenances shall be so located at a distance from the right of way line of any State Highway that none
of the right of way therefore is required for use of the patrons or customers of any such establishment.Grantee shall comply
with local building codes. Set-back requirements for the location of buildings in relation to the right of way line are a function
of local authorities, and they should be consulted regarding requirements that must be adhered to.
DOT Form 224-713X
Revised 9192 Page 1 Exhibit "A"
10. The Grantee agrees to schedule the work herein referred to and perform said work in such a manner as not to delay the
Department's contractor in the performance of his contract.
CR 11. Work within the right of way shall be restricted to between the hours of 8:30AM and 4:30PM , and no work shall be
allowed on the right of way Saturday,Sunday,or holidays,unless authorized by the Department.Any lane closures must be
submitted for approval in advance of use. The hours of permitted closure may differ from the above noted hours.
® 12. The shoulders, where disturbed,shall be surfaced with crushed surfacing top course three -inch minimum compacted
depth,or as directed by the Department.The surface of the finished shoulder shall slope down from the edge of pavement
at the rate of Yz inch per foot unless otherwise directed.The restored shoulder must not have any strips or sections less than
2 feet wide. The restored shoulder shall be surfaced with asphalt concrete pavement.
54 13. The Grantee shall be responsible for constructing and maintaining the access connection(s)and appurtenances between
the shoulder line of the highway and the right of way line inclusive of surfacing and drainage.The Department has the right
to inspect all installations at the time of construction and at any time afterward and to require that necessary changes and
repairs be made. Unsatisfactory work will be corrected by the Department, at the Grantee's expense, or access may be
removed at the Grantee's expense.Directing of surface water from private property onto Department right of way will not be
permitted.
B 14. The access connection shall be sufficiently surfaced back an adequate distance from the edge of the pavement to prevent
any tracking of material onto the highway.Any tracking of material onto the highway shall be subjectto enforcement of Chapter
46.61.655 RCW and shall be immediately cleaned up by the Grantee or the Grantee's agent.
❑ 15. Standard highway warning signs designated as "Truck Crossing"sign, plate W11-6, shall be placed and maintained at
Grantee's expense on each side of the access connection.Signs shall be in evidence only when access is actually being used.
If necessary,flagmen shall be provided.Sufficient parking space shall be provided by the Grantee outside Department right
of way so no vehicles will be parked on said right of way.
IX 16. All manholes,valve covers,and like appurtenances shall be constructed at such an elevation to conform to the shoulder slope
from the edge of pavement or as directed by the Department.
9 17. All slopes, slope treatment,top soil, ditches,pipes, etc.,disturbed by this operation shall be restored to their original cross
section and condition.All hazards shall be marked by warning signs, barricades, and lights. If necessary,flagmen shall be
employed for the purpose of protecting the traveling public. Roadside operations shall be specified by the Department's
representative.
X 18. During the construction and/or maintenance of this facility, the Grantee shall comply with the Manual on Uniform Traffic
Control Devices for Streets and Highways. If determined necessary by the Department,the Grantee shall submit a signing
and traffic control plan to the Department's representative for approval prior to construction or maintenance operations.
19. Bond coverage required to ensure proper compliance with allterms and conditions of said permitwill befurnished by a Blanket
Surety Bond held at Headquarters in Olympia.
N 20. A surety bond in the amount of$ 2,000.00 written by a surety company authorized to do business
in the State of Washington,shall be furnished to ensure compliance with any and all of the terms and conditions of this permit
and shall remain in force until all work under this permit has been completed and approved by the Department.
s 21. Relative to advertising adjacent to all State highways,we wish to call your attention to the Scenic Vistas Act of 1971,Chapter
47.42 RCW and State Transportation Commission ruling Chapter 468-66 WAC. Violation of this section of the statutes will
be sufficient cause for cancellation of this permit. On-premise signs are allowed.
22. The Grantee shall notify the Department's representative upon completion of the work under this permit so that a final
inspection can be made.
i'd! 23. No lane closures shall be allowed except as approved by the Department representative.Approvals may cause revision of
special provisions, including hours of operation.
;ie' 24. The responsibility of the Grantee for proper performance,safe conduct,and adequate policing and supervision of the project
shall not be lessened or otherwise affected by Department approval of plans, specifications,or work,or by the presence at
the work site of Department representatives,or by compliance by the Grantee with any requests or recommendations made
by such representatives.
e 25. All material and workmanship shall conform to the Washington State Department of Transportation Standard Specifications
for Road, Bridge and Municipal Construction, current edition, and shall be subject to inspection by the Department.
ADDITIONAL "SPECIAL PROVISIONS" SEE PAGE 3.
DOT Form 224-713X
Revised 9192 Page 2 Exhibit "A"
M94-0053 ' Page 3 of 3
Mr. David T. Evans
9381 Highway 106
P. O. Box 66
Union,WA 98592
SPECIAL PROVISIONS (Continued)
X 26. Any future development, or change is land use, of this property will require
review and approval by both WSDOT and Mason County for adequacy of this
approach for the intended use.
X 27. This approach shall be constructed to meet the Type "A" road approach standards
(See attached plate). The construction of this approach shall be as close to a
90 degree angles as possible so as to provide optimum sight distance in both
directions and at a location acceptable to the Department. The slope from the
edge of pavement, out to the centerline of the culvert plus a foot shall be
constructed at a minus 0.02 feet/foot down and away from the highway. The
culvert shall be laid to the true flow line and have beveled end sections added.
X 28. Special care should be taken during construction of this access to insure that
water from this approach will not flow onto SR 106. Any problems created by
surface water runoff directed toward the state highway must be alleviated at the
Grantee's expense.
X 29. Asphalt paving of this access shall be extended from the shoulder line of SR 106
out to the right-of-way line at the Grantee's expense. All materials used within
the state right-of-way shall be to WSDOT standards.
X 30. There will be no advertising signs or bill boards erected within the state right-of-
way.
X 31. Any proposed landscaping or fencing within the Department's right-of-way must
not infringe on the sight distance or the roadside clear zone. The disturbed area
within the Department's right-of-way shall be contoured, graded, seeded,
fertilized, and mulched at the Grantee's expense to reduce erosion and problems
with surface drainage.
X 32. Special care should be taken during construction of this approach to insure that all
underground utilities have been identified, located and measures taken to
property protect them. The Grantee is responsible for all coordination, work and
expenses associated with any utility relocation.
X 33. The Grantee is responsible for obtaining a construction permit and all other
pertinent permits from Mason County or other agencies, if applicable, prior to
beginning work.
X 34. The Grantee shall use the approved traffic control plans as provided in Exhibit
"C". It is the Grantee's responsibility to provide adequate traffic control and
protection to ensure the safety of the traveling public, all personnel, and
equipment, working within the state right-of-way. If necessary, the Grantee shall
provide certified flaggers for the purpose of protecting the traveling public.
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nti
GENERAL NOTES
Slpn Spockv • x Ifeet) Floodlights shop be provided to mark
flogger stations at night.(Flares may
y Rural Roods be used for emergency operations.)
/0/SS MPH 500 r
\` �� ArterlaM If entire work Oreo Is visible from one
z \ Rialdentld i1e 25/35 MPH 250r station. one flogger may be used.
sueineq Oletrlct•
ff
Steady burning warning lights (TYPE C. MUTCO)
' may
nl e used
nto mark chamellzing devices
of
SA �.
0 Chonnellzing devices are to be extended to
0 point where they are vlslble to 0ppr00ching
1 ° traffic.
1
�I Sign sequence Is the some for both
40 directions of travel.
Y20-7A
e8"x40" The maximum spacing between chomelizing
B/O devices In o taper should be nearly equal
In feet t0 the speed Ilmltl the maximum
w20-601 spacing between chomellzing devices used
+e"x+e" to separate traffic should be 2 times the
0/0 speed limit.
BE
PREPARED wzo-e
0 STOP +e"X40*'
B/0
9, } NE LAN
ROAD W20-1
AHEAD ee"x48" w21-4
e/0 +B"zee..
9 THIS PLAN MAY NEED TO BE ADJUSTED TO Fit SIIE CONDITIONS. 8/0
} ROAD ROAD
REFER TO THE MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES (MUTCD)
I PART VI DR CONTACT THE TRAFFIC CONTROL ENGINEER. ONSTRUCTION OR WORK
9 } AHEAD AHEAD
LEGEND � APPROVED
e° TRAFFIC SAFETY CONES -III,MIN \
N to
:1 a SIGN LOCATION - TRIPOD MOUNT
LAGGING STATION G�__Ii-�-
C F TRAFFIC ENGR
ALTERNATING ONE-WAY TRAFFIC
s �cP�of nu(i TATI FEO.A10 PRDJ.MO.
oEsIcNED T PROGRAM DEVELOPMENT
ENTERED_BY M.e to . �As DIVISION ' 1Fse oington State
T cwmb iit—F N
/Rp,j. iw". area DOWfeent of Transportaflon
DISI. ADM.
- awsn r4
DATE AT REYlsla BY TRAFFIC CONTROL PLAN
BUFFER VEHICLE DATA
TYPE OF WEIGHT OF LENGTH OF BUFFER SPACE MINIMUM TAPER LENGTH ILL IN FEET
SHADOW SHADOW '
VEwCLE VEHICLE NOPERATION
MOVING ►os Hd SpNa I�phl
(LOADED) 4BS.I OPERATION i5 ]0 SS .0 MSI TON TRUCK q,000 •750' ( NOS ISO 20S zT0 .50 Soo SSOAVARO2I,000 •60' Rtu — IAS T25 iri .ri . a05
_ DUMP TRUCK 4*
•ROLL AHEAD STOPPING DISTANCE ASSUMES j 1 125 IIO 2.5 ]iO SM A0p A{Q
S 55 MPH IMPACT SPEED.DRY PAVEMENT.
W S GOOD LOCKED BRAKES,GOOD IYiES.
S�
SIT,Spocirp. ■
= Rural Road. b�S MPHS00'�
W�1 All.,1plf
Urpo�S"'
R.flWntldl t
—� � _� euf lntsf Dlf+rlctf
q p O O O
O ® N RK O
AREA
% IT L/S
ROAD SHOULDER
CONSTRUCTION WORK GENERAL NOTES
W20-I AHEAD W21-5 The maximum spacing between chonnelizing
4B'x4e• IB'xIB'
B/0 0/0 tlevlces In a toper should be nearly equal
In feet to the speed limit;the maximum
OR spacing between Ghomelizing devices used
to separota traffic should be 2 times the
speed limit.
ROAD
WORK APPROVED Buffer vehicle may be O work vehicle.
Wr_4 AHEAD
4e•x".
8/0
i.RAFFIC ENGR LEGEND
COO TRAFFIC SAFETY CONES - C'MN
q THIS PLAN MAY NEED TO DE ADJUSTED TO FIT SITE CONDITIONS. SIGN LOCATION - TRIPOD MOUNT
a REFER TO IHE MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES IMUTCO)
PART VCR CONTACT THE TRAFFIC CONTROL ENGINEER. BUFFER VEHICLE -MAY BE A WORK VEHICLE
SHOULDER CLOSURE
if yri_w. •�Dlli _ TATE FED.AID PROJ.NO.
DESIGNED BY PROGRAM
DEVELOPMENT Yoehington State
10 YAS
ENTERED BY M.Y. • Departnent of TrOnsportotlon
i CHECKED By F.N, r r•
►ROJ. EMGR.
DiST. ADM, a"•" TRAFFIC CONTROL PLAN
DATE DATE REVISION BY
Existing Shoulder Width
2 0' R
Culvert Pipe with beveled end
treatment see Chapter 640
10' MIN
001
- 14' to 30'
Asphalt Concrete- as necessary
to fit conditions
ZContinue 20' radius
as required if approach
is at an angle.
20' R
For Mail Box location see Figure 730-1
Edge of Pavement
-When the travel lanes are bituminous, a similar
type may be used on the approaches.
*15% M AX
Shoulder Slope 20' MIN
'-2.0X MAX
Vertical Curves not to exceed a 31/4" �-lMAX
hump or a 2" depression in a 10' chord.
--Difference from shoulder slope.
NONCOMMERCIAL APPROACH TYPE A
Figure 920-1 a
92�-2 Design Manual
March 1991
Groove end always laid upgrade
NOTES
------- ----------------
r I. The culvert ends shall be beveled to match _
the side slope. Field cut of culvert ends is
r permitted,when approved by the Engineer.
________ 2. All field cut culvert pipe shall be treated
"' """"'""- -' "- with treatment as shown in the Standard
Specifications or General Special Provisions.
PLAN
End section
--------------- ---- - -- See note I
i
-------------- ---------------------------------------------------------
Included in culvert length for payment
ELEVATION
CONCRETE PIPE
End section
1'MIN
See note 1
�1
BEVELED END SECTIONS
•lodook ,noon nrw� v aV�
Included in culvert length for payment kr
ELEVATION �`^`,� o a �—
r M.n wms num
METAL PIPE 9-17-90 Revised 4" MAX dimension on Concrete Pie AB :s.Me:
9-29-09 Remove I'MN dimension from Concrete Pie IT
6-12-66 Revised note 1,added note 2 ST STANDARD PLAN B-7o
12-4-86 Revised bevel, title block & notes MZ
T
1
ASSIGNMENT OF ESCROW ACCOUNT
This assignment is for the purpose of fulfilling the requirement of bonding collateral for
Permit M 9 4-0 0 5 3 . The undersigned does hereby assign, transfer, and set over unto the
State of Washington all right, title and interest in and to $ 2 ,000.00
on Savings /Account in the S e a f i r s t Bank,I
in the
name of D. T Evans & I . Evans full power and authority to demand, collect, and
receive said deposit and to give receipt and acquittance therefor for the uses and purposes
prescribed above. It is understood and agreed that Shelton
Branch, S e a f i r s t Bank holds the Certificate covering said account
in its possession and agrees to hold $ 2 , 000.00 until a release of this assignment from
the State of Washington is received. The interest shall be payable to D. T. & I . Evans
Signed and dated at Shelton Washington this 4 t h Jay of
August 1994
I
82560285
r
Account No. Signature D id T. Evans
Signature Irene Evans
P.O. Box 66 , Union, WA 98592
Address
ACCEPTANCE
The undersigned hereby accepts the foregoing Assignment of Escrow Certificate, Voucher
Number , in the amount of $2 ,000.00 this
_day of
1994
Seafirst Bank
Escrow Officer BANK
206-426-8295 P.O. Box 640, Shelton , WA 98584
Phone No. of Bank Address of Bank