2005, 06-14 Permit Application: 05002016 Road Obstructioni
Ca1124 bouts before inspection xcquircd
Thom 59.688-0036 Faz 509688 -0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date Permit # PW
ROW CONSTRUCTION PERMIT
l.ocatlon of property, '3
,(� (Address/Parcel #, ff available)
Applicant Name &j\& Y tiD1Q_
Address '630-3 t . 61k, Phone "iS`7l—'1iSt1
Contractor's Name H 4- 3 �ir s± y 4<-C+L O n
Add, 7 if llaJky Way Phone 92Z -191c
Contractors Rem Co Ai / If
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
()L Sewer Connection
n cu,,b& Gutter
flcb&ondut
Other
Pavane,' EstC
1
i
1
1
Driveway
Gas instaKadon
Sidewalk RepaidConstruction
DInienalons
Band arena certification crust be on Hie with the may_ Bond It
SPE IAL CONDITIONS=
Parmittee Signature
Approved
1 booby settled= Ulu City of Spokane Valley b cage the tee for ibis permit b my cruet card.
Card 1 Expiration Data
Name of Heider
Fees Pa1d_
(Application) (Inspection)
In addition to the permit application foe of $16.00 or $25.00, Inspection on each permit will be
biped to the permittse at a rate of $60.00 per hour with a $26.00 (1/2 hour) minimum. Per mittee
signature on permit constitutes an agreement to these terms and provisions.
Work completed satisfactorily {Signed) Date
Date !nit
• .. t... __ u, rw .., r,..lt M.+ Hews TirIrnd' # nn tared here