HomeMy WebLinkAboutRAP5014 - RAP Permit / Conditions Road No:
6)C.ec�rb�
Road Name: Si mmC?n�
MASON COUNTY ROAD DEPARTMENT
411 North No Fifth
1
fh
Shelton, WA 98584
PERMIT
Subject to all terms, conditions and provisions written or printed below or on
any part of this form,
PERMISSION IS HEREBY GRANTED TO:
Address: 5E 130 L�h�h R,� . rSLI.61 98SEW Phone: `2_c- -6( 7$
To install a �oac Auo�octch
Location: W / 4 (W=a -4-2—L
Legal Description: t'ar+ions o�- SW% , 5W Y4 Scx , 0 � T 19N R 3'W, WM
REMARKS: 11-A t-ck +r a c.iu( 4 becau—<Al- JccLkioV1
Is cd }(,\e c_yesi o bill . The cxnn,�Y�h �S feitil[�e�ar u
A Bond in the m u t f $ 5-0 `�"- com anies this permit.
(Rct. # � Check # � .)
Contractor: jw(c,- Qc4eA Ste. Address: SE 13o f�A Sk e(-1 k`a. 9pSEy
Phone: `fz6 -617C, License No: '1411)VT Expires: _ 0-?,y 9S
w
No work shall be done under this permit until the party or parties to whom it
is granted shall have communicated with, and received instructions from the
Road Supervisor ; Phone: 427-9670 extension 450.
This permit shall be void and bond forfeited to Mason County unless the work
herein contemplated shall have been completed on or before:
, 19
DATED at Shelton, Washington, this day of 19
Issued by:
CONTACT OFFICE WHEN ACCESS
IS COMPLETE FOR FINAL INSPECTION 111tle: