Laserfiche WebLink
. , - , <br /> , . - <br /> T � • <br /> Return Three Copies to Olympia-Complete in Full -Carbon Paper Not Naeded <br /> WASHINGTON STATE <br /> Mail With Proper DEPARTMENT OF TRANSPORTATION <br /> . . Fee To: �► Highway Administration Bldg.,Otympia,Washington 98504 <br /> / �Q/ � ATTENTION -OUTDOOR ADVERTISING CONTROL DISTRICT NO. --�— <br /> �_Q.c1/ <br /> ppPLICATION-OUTDOOR ADVERTISING SIGN PERMIT <br /> . o:.-,.,xw, <br /> TYPE OR PRINT Name and Mailing Address of Owner of Sign in Space Below FOR STATE USE ONLY <br /> / . �.-. DATE RECEIVED OLYMPIA -D�{-���,�q-- <br /> NAME �G�- VEAR ��u-- <br /> ����� �+ PERMIT NO. Q�� � �Iq <br /> ADDRESS �� v ASSIGNED: ��n-� TAB NC. <br /> �� CITY `���/--!/rF DATE PERMIT ISSUED: 4'� ! ' 7 1 <br /> _� INVENTORY NO.: � �.I S'L � , <br /> � STATE _---•--�-- ZIP �� CONTROLSECTION: � � ^=�--- . <br /> ���777��jj 0.5.M.P.: _ Z. GS <br /> p � S.R.M.P.: S .f4 <br /> i DATE: ��blv ���O�a--r— 13 9 G 7f <br /> � <br /> � � LOCATION OF SIGN: �� <br /> . � STATE HIGHWAY NUMBER SIDE OF HIGHWAV N ❑ E ❑ S � W � <br /> � , y DIRECTION&DISTANCE FROM CENTEF OF SIGN FACING N ❑ E ❑ S CY W ❑ <br /> � N'•AREST CROSS RD.OR ST.IN FEET <br /> . ' SIGN DESCRIPTI N: �j �/''� � . :�� <br /> I SIZE: Ft.X � Ft. TOTAI.AREA 5�.FT. _1 J=SL__ <br /> ' SHAPE: RECTANGULAR'�.I SQUARE ❑ OCTAGONAL Q ROUND ❑ OTHEF ❑ , <br /> I _ �� &>� �_3��_CL�',�.� ' Q n� � <br /> j OTHER: Dascribe pre.ti-E- <br /> ! / <br /> j NAME AND ADDRESS OF ACTIVITV BEING ADVERTISED: <br /> Fea: $10.00 Per Sign Face <br /> Make checks or remittance payable to: <br /> � Department of TranspOrtation SIGNATURE _ �-�.I �F�1�� � <br /> Sign Ownar <br /> � .... ""..................""""•-:..........."'..........""........_........""'...................,...._.......""""""..........._..............................._..... <br /> � AUTHORIZATION OF OWNER OF LAND ON HIC SION IS ERECTED OR MAINTAINED <br /> ' NAME � �C�� ADDRESS <br /> CITY 6TATE Z�� <br /> l, the undersigned, have consented to the erection and mainienance of the above described outdoor advertising <br /> sign on property which fl own) (l /easel in conformance with Washington Outdoor A�lvertising Contro/Sign Law <br /> (Chapter 62, Laws of 1971/ and the T�ansponation Commission rules and regulations for outdoor advertising <br /> control a/ong/nterstate, P�imary and Scenic routes. <br /> 91GNATURE <br /> � Property Owner <br /> p COPY OF LEASE ACCEPTED IN LIEU OF SIGNATURE � <br /> This permit shall not be considered to allow a sign to be erected or maintained that is otherwise prohibited by Statute or by the <br /> Resolution or Ordinance of any counry,city or town of the State of Washington. <br /> � <br /> Signature of Department of Transportation employee � <br /> validates this permit and acknowledges receipt of <br /> fee paid. ev — <br /> For Department of Trans ation <br /> Form 224�018 <br /> DOT Revised 9/77 <br /> ' <br />