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� <br />Retum Three Cepies to Olympia - Completa in Fui! -- Carbon F:iper Mot Neederl �/ _� � <br />Mail �b'ith Proper WASHING (ON Sl"ATE <br />FeeTo� �♦ DE?ARTMFNT OF TRANSPORTP.TIOIV <br />Highway Administration 61dg., Olymp�n, W�sh�ngtor� DR5Ci4 <br />AT7[NTIOM �OUTDOOR A�VER"fISING CONTRGL. <br />n ,ri+ir. r �:o. _.� <br />e4PPLICATIC,I�I�-C7iJT���R �►���&�TiS�(Vf� SICi� i�Ef�1V1BT <br />o:s.,.,Hxi <br />TYPE OR Pfi INT Name and �4iailing Address of Owner of Sign in Space Be:ovi <br />� ----_ --- -- --- <br />D' Y12IP.1C .ci1 �Il �',OCi F,i7P- <br />NAME __ .I ___�__� ._.,�------- <br />ADDRESS _ IIOh 14G0 __ _____ <br />CITY Be� � � i]�h�m _ _____ <br />S�.aTE ���� h�ngton <br />��H ._9�227 <br />FOR STATE US[ ONLY <br />UATERECGIVF.DULYNPIA .�^2Zp-�� <br />PERMIT NU. �/ YEAH _L! �B <br />ASSIGNED: __. �� fO _ TAB UO. v�" <br />DA7C PERMIT ISSUCO� _(�'f�r/� <br />INVLNTORY NO.: ._____.���_____ <br />CONTROL SEC710N: ` ' � �� _____ <br />cs.m� r.: ----� -- <br />i:arch 2r� ,� � s�.n^.�.: �'<_' -- i <br />DATE: —_. _ 19 " <br />-- ---- ---- I -- —�--------T� <br />i � � J • �' % .�. r,.' <br />,�i��'i �.' .� i.: �. <br />LOCATION OF SI3N: - ( •>j� � - <br />STATE HIGHWAY NUMBER 5 _ SIDE OF HIGHW�V N ❑ E ❑ S ❑ W� <br />DIRECTION & DIST�NCE FROPd CEN7EF OF SIGN Fqf.WG N � E I] ,. ❑ N' U <br />NEAHEST CFiOSS RD.OR ST. IN fEET i.��.���!1_y�-.._ N�� <br />SIGN DESCRIPTION: <br />'. SIZE: fi __ Ft.Y - 1�- <br />SHAPE: riBCTANGULAH i� <br />OTHER' Dc+.ribe <br />Ft. TOTAL ARF.A SO. �T. tµ rl—_ ____ <br />S�U/1HE ❑ OCTAGONAL ❑ 17OUKU ❑ <br />OTHF:R C� <br />NAMEANDA�DFiESSOFACTIVI7YFiEINGAGVERTISED: ('�li:;-1-;1G�•:r-�:-.L-d::-1�K1—I.-�- :3-S—F�L��Ci:..-+---yt;-.L:6-'`yC-TE1-i:I7.sL�- l.-ii;:i. <br />Fee: 510.00 Per Sign Face —..-------------- . -------- <br />fdake checks or ;emitiance paya6le m: --------- --- '�--=-�"---��-.--- <br />`--- <br />Or.partment of Tr�nsportat�on � � si�rantu�tze ___.._ _. ___ _. __ __. <br />r n O:vnr. <br />� 'i i: i, I��i1:7t71Y1,':'Sµ <br />............._......_....._._........_._......._...____.._._._.. _ __.......... . . . __._ _-__.._-_.._....... ._. <br />AUTHOHIZATION OF OWN[H OF LA^1D ON VJHICH SIGN IS ERECTEU OR !,1�INTA WED <br />. . .. <br />NnM1,1E -�SU£G�-id�s'#li1E�'....�-�ic1-.�Sp_e_._IC;G..-_. nDDFESS .__.j<;...'__.'.ii-t:.�-'k�: ....-j��..- __--- - <br />�.. _ <br />CITY __?�.u_Y:,j.SY' ZLC_....—.- . __—_____.___ SfATE "n,• � • .� <br />_-- ---�L�__71I1C�.��4iL--_--_.------- 2iP _ :i: 7�.� <br />l, the undersigned, have consented m the erecrion and maint�nance of the above described outdnor adverrising <br />sign on property which Il ownJ (l leasel in conlormance v.�itlr �Vashingron Outdonr Advertising Control Sign Caw <br />lChapter 67, La�vs of 79711 and the Trensportation Canmisslon ni/es and regulations for outdnor advertisin� <br />control a/ong lnte�state, Primary and Sr.enir. routes. <br />9 G N A TU ii G... _.__- __..____ __ ._____._ _ <br />PeoPetlYU'�n�nVr . .�_�'� <br />A COPI' OF LE�SE ACGEPT'ED IN LICU OF SIGNATURE <br />7his permit shall not be considrred te allnv,� u si9n to be erer.�ed or maintained ihat is otherwisc prohibited by Statutc or by ihe <br />Resolution or Ordinance of any county, ciry or ,o'�vn of the Slate o( lVashing[un. <br />Signature o( Department of Transportation employee <br />validates [his permit and .r.knowlr.cl9r,s ruc��ipt of <br />fce paid. <br />Unl. Fam',':'401H <br />i7<i�n�:�: q�/7 <br />e� _ _r�i � .�%���l2Z�'T�'� . . . . . . _. <br />Foi Deparllnen: nt T�unSPoiinhun <br />