HomeMy WebLinkAboutReimbursable Work Request - Public WorksK23-111
G� GRANT COUNTY
REQUEST TO THE COUNTY ROAD DEPARTMENAPPROVED,
FOR REIMBURSABLE WORK
To The County Engineer: MAY Z 3tUl3
Pursuant to terms of an agreement between the County and Co`SENT
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(Name of Requesting Agency)
adopted and approved on 3*110197(n =L� the undersigned hereby requests the
County to perform the work listed below at a time and in a manner convenient to the County. The
undersianed further requests that the work be completed no later than
� � •� � �'
and hereby guarantees reimbursement to the County for all work done up to a maximum. of $ 03G Arlqc� -0
Work to be Completed:
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DATED:
SIGNATURE
(Agency Representative)
TITLE
To The Board of County Commissioners: DATE S * ZS . *23
I have examined the above reqUest and made
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Approved A
C 'i Road Engineer/Brior"ector of PublicWorks
Denied
Action of the Board Of County Commissioners: DATE
6- — z- .3, - z-- 3
The Engineer's recommendation is hereby approved.,
The Engineer's recommendations is disapproved or modified as follows:
st:
r.
Cler of the Boegv
Recommended for use vvitfi Section 2
of Form: CRAB 9101 and WAC 136-32-030
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