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� :�r. ; �` r'. <br /> � APPLICATION FOR PERMIT <br /> T ��� OR FRANCHISE <br /> ' -// DI5TRICT 7 � <br /> ; 15325 SE 301h PLACE FOR DE�P TMENT USE ONLY <br /> ; BELLEWE,WASHINGTON 98007-6597 C S 3�T`�� <br /> r2 ID �3y <br /> � Telephone: (206)562-4253 FOR COUP(TIES: ISLAND, KING,SKAGIT,SNOHOMISH, <br /> HAT M 8 PART F PIERCE <br /> � Attention: District Utilities Engineer �j C� � �� � 1 <br /> 1� <br /> � APPLICANT PLEASE PRINT OR TYPE ALL INFOpMAT10N <br /> � <br /> � APPUCATION IS �ILITY PERMIT � UfILITY FRANCHISE FRANGHISE NO. AMENDMENT NO. <br /> � HEREEY MADE <br /> � FEE 5150.�0 FEE Y500.00 ❑ �g3pp.00 <br /> � FOR A: ❑ ��E FEE$300.00 � FEE$250.00 ' <br /> Intendad use of State Right of Way is to conswct,operate and maintan a, g�� Gravity Sanitary Sewer Line. <br /> , <br /> . <br /> 3 <br /> i <br /> � <br /> � <br /> j� State Route No. SRS ��^lY Snohomish <br /> ' � At Mile Post /or/From Mile Post To Mile Post <br /> ,j 188.80 188.97i' <br /> �� Beginning In Ths NF 1/4 Of The SE 1/4 Of Sea 1g Township Zg North;Renge 5 �Eest W.M. <br /> , <br /> � Ending In The � 7/4 Of The gW 1!4 Of Sea 17 Township 28 North;Renge 5 �IR�tlEast W.M. <br /> � Fees in the amount of S S��y �e peid herewith to detray ihe basic adminisVaUve expense incident to the processing of this <br /> '' application according ro WAC 468-34 end/or RCW 47.32 and amendments thereto. The applicant funher promises to pay addi6onal <br /> amounts as shell be blled,if eny, in reimbursement of:he actual costs of the Departrnent. <br /> Checks are to be made payable to'Weshington Stete Depertrnent oiTrensportation.' <br /> The undersigned submita said applicatlon and accepts ths condiuons as set forth. � <br /> � Famil Tree Associates <br /> � ' ��� ; For Consultant Use Only . <br /> S00 lOBth Avenue N.E. #800 <br /> � Bellevue. WA 98004 T'acs.�sc �ttst7.aeerin� �oinD�aa9 <br /> 4� �fiHct�uw s : <br /> � GIY-8fA7E•aPC00E <br /> (206) 646-7327 ��� ���ve 8ark £ast,; �a��� �� <br /> � .._.--� � �_. �� ': 9ea��1�, NA 58188 <br /> �� �' an ar�h �moE <br /> � X ��,../' / �/� {2t36� 43I-7970j <br /> 2ED9G <br /> "n ""� �i 7EtEPNONE �. : - <br /> /ack g rs _ <br /> -�d ��� �.CONSWTNA'SP@q6FN��71YE <br /> : �� Ti'S�d1A <br /> a ` AklarypNrir ;: :� . <br /> � pated this I 01~ day of Q���- 191.L. <br /> J <br /> D�T �?D1eo SEE i1EYERSE SInE FOp A1lDITIONAL INFOHMATION <br /> . I <br />