Trip Permit - Clark County, Washington
|[pic] |Clark County Public Works |County Permit |Trip Permit | |
| |4700 NE 78th Street |City of Van. Permit |30-Day Permit | |
| |Vancouver, WA 98665 |County & City Permits |Annual Permit | |
| |Phone: (564) 397-2434 | |Manufactured Home | |
| |Fax: (564) 397-6106 |Same Day Return Trip | |
| |Email: PWOverlegal@clark. | | |
|OVERSIZE/OVERWEIGHT VEHICLE PERMIT APPLICATION |
| |
|NAME: | |ADDRESS: | |
|CITY: | |ST: | |ZIP: | |
|DESCRIPTION OF LOAD OR VEHICLE: | |
| |
|ORIGIN: |I-5 @ LaCenter MM 16 |DESTINATION: |I-5 @ Woodland MM 21 |
|ROUTE: |Exit #16 off I-5 east to NW LaCenter Rd to NW Pacific Hwy to NW Hayes Rd @ Bridge 80 enter Cowlitz County |
|***APPROVAL FROM COWLITZ COUNTY IS REQUIRED 360.577.3030 EXT. 2527*** |
|GROSS WEIGHT: | |OVERALL WIDTH: | |OVERAL|
| | | | |L |
| | | | |HEIGHT|
| | | | |: |
|TRACTOR AXLES: |
|STATE OVERLEGAL PERMIT # | |STATE TRIP PERMIT # | |
| | | | | |
|PERMIT START DATE: | | | | |
|READ THIS BEFORE SIGNING: This combined application/permit issued in accordance with R.C.W. 46.44.090 with the specific understanding that all applicable Washington |
|State, County, and City Laws, Administrative Codes, Regulations and Conditions, including those not listed hereon will be complied with. I, the undersigned permittee |
|or agent thereof, certify that the information shown herein is known by me and is true and correct and understand that the permittee shall be liable as set forth in |
|R.C.W. 46.44.110 for all damages to any public highway, bridge or elevated structure resulting from the movement of equipment authorized by his permit on the public |
|highways of this state. The permittee shall further hold blameless and harmless and indemnify the county, its officers, agents and employees against any accident, |
|liability, loss, injury, action and the costs thereof arising from the conduct or operations of the permittee in connection with this permit. I further understand |
|that prior to movement the permittee shall establish a routing to safely detour all structures having a limited clearance less than the permitted height. |
|SIGNED: | |DATE: | |
| |Permittee/Agent Thereof | |
| |
|CREDIT CARD NUMBER IS REQUIRED: | | | | |EXPIRATION: | |
|****FOR OFFICE USE ONLY**** |
|Comments/Requirements: | | |
| | | | | |
|****NOT VALID WITHOUT STATE PERMIT**** This permit must be carried on the above described vehicle. Permit subject to cancellation if state/county/city requirements |
|are violated. |
| | | | |Manual Approval: | |
|Clark County Public Works Signature | |Date | | |Initials |
Northbound Bridge 80 Detour Check One: Check One:
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