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Dept. of Public Works <br />Name: CHAr>T 1 L4 A L Lois �l - t2 r3� Gc 5 <br />Mailing Address: 344, IE 4Naw4Y ivt I Vi � <br />City/State/Zip: CLZztUM, WA g892Z <br />Day Time Phone: SDg 26o IZIo <br />Email Address: <br />I certify that I am familiar with the information contained in this application, and that to the best of my <br />knowledge and belief such information is true, complete, and accurate. 1 further certify that 1 possess the <br />authority to undertake the proposed activities. <br />Date: <br />1(-I(o-1(P <br />Name: D\\hG>_l-T wATSorJ Laf5 tS-I -i7 gLK5 <br />Mailing Address: 26425 5 Fbg"e- SVA,.[ LOT 6 QL-KZ <br />City/State/Zip: 1-11-4NWccxD,WA g26o36- <br />Day Time Phone: <br />Email Address: <br />I certify that I am familiar with the information contained in this application, and that to the best of my <br />knowledge and belief such information is true, complete, and accurate. l further certify that I possess the <br />authority to undertake the proposed activities. <br />Sign ur of Petiti er: Date: <br />X � U� <br />Name: L r N D A A /AMMO u S L -c iT to 3LKS <br />Mailing Address: _ 125Z& W 5"LA 2t< DIZn/E <br />City/State/Zip: SWJ C WEST AZ 815375 <br />Day Time Phone: <br />Email Address: <br />I certify that l am familiar with the information contained in this application, and that to the best of my <br />knowledge and belief such information is true, complete, and accurate. 1 further certify that I possess the <br />authority to undertake the proposed activities. <br />Signature of Petitioner: <br />Date: <br />411 North Ruby Street, Suite 1 TEL (509) 962-7523 <br />Ellensburg, WA 98926 FAX (509) 962-7663 <br />Page 2 of 3 <br />