HomeMy WebLinkAbout2003, 07-29 Permit App: PW00000366 SewerCity of
SPOKANE VALLEY
UTILITY RIGHT — OF — WAY APPLICATION AND PERMIT
PUBLIC WORKS DEPARTMENT Date project starts
Date Project ends
(Please call for final inspection)
APPLICATION
Location of property involved (or address) 6/61 / Y . poc')e,
Name ofcompany � 'e f 0
Address of company p, Q • 0--l4 ( 3 c / phone Q% 1 '9 % L/?
Contractors name
Contractors address 0 . lJU-( ] '3 c-/ ( phone 2C1 I _ 7? -P
Contractors registration Number - /jam f � 0 %7 RH Expiration date (X y
PERMIT # PW 1P
Right of Way:
Pavement or sidewalk intrusive. Yes No
Intrusive outside of pavement or sidewalks. Yes No
Length of cut ft. Depth of cut ft. Width of cut ft.
Direction of cut
Contact person
Address of contact
Phone
Please explain in detail the description of the activity proposed. ,S�%,_ O 6 S1 -r (,l( (f �-
%j s o0 -ALA_?
I hereby authorize the City of Spokane Valley to charge this permit fee to my charge card.
Visa mastercharge
Valid Date
Print name of holder Signature
PERMIT:
Restoration: Permanent Temporary
Type of back fill to be used: gravel Crushed CDF
IS A COPY OF A BOND DEPOSITED WITH THE CITY OF SPOKANE VALLEY ?
A COPY OF THE CITY / UTILITY LIABILITY INSURANCE POLICY MUST BE ON
FILE AT THE CITY.
PERMIT FEE $ ,Cr:› INSPECTION FEE $
Approved
Public Works Director Date
CALL 24 HOURS BEFORE INSPECTION NEEDED
Phone 509-688-0036 Fax 509-688-0037
R - 0 - W APP.