2012, 06-08 Permit App: ROW-2012-0218 ROWa Permit Center
Spnokane 11703 E Sprague Ave, Suite B-3
`�'' Spokane Valley, WA 99206
v�jjQy (509)688-0036 FAX: (509)688-0037
www.spokanevallev.org
Community Development
ROW Construction
Permit Application
❑ Driveway
❑ Sidewalk
Road Obstruction ❑
gob3- 2C)\2,-- OZ)%
PERMIT NUMBER:
PERMIT FEE:
❑ Pavement Cut **(see below)
❑ Curb & Gutter ❑ Other
(traffic control plan required)
PROJECT ADDRESS 2326 S Balfour Rd
START DATE 06/12//2012
Tier
ANTICIPATED COMPLETION DATE 07/12/2012
Building Owner:
Contractor: Avista Utilities
Name:
Name: Avista Utilities
Address:
Address: 2406 n Dollar
City: State: Zip:
City: Spokane Valley State: WA Zip: 99212
Phone: Fax:
Phone: 495-4152 Fax: 534-2463
Contact Person
Contractor Lic No: Exp Date:
Name:
City Business Lic. No:
Phone:
Type of Work Condition of Cut
Gas X Avista gas crews installing new service job # 540315013
Electric 10 ft east of cl of balfour blvd to east side of home where meter is located
CATV
Communications
Sewer
Other
Type of Repair Existing Road Condition
Asphalt Depth of Asphalt
Concrete Depth of Gravel
Asphalt Concrete
Width Length Width Length Locate# 12120537
X
X x
BOND/INSURANCE CERT #
Signature Amy Cole
Method of Payment:
❑ Cash
Bankcard #:
Authorized Signature:
❑ Check
(PER SVMC TITLE 10 ARTICLE 2)
Date° 6/07/2012
❑ Mastercard
Expires:
❑ VISA
VIN#:
Work completed satisfactorily Date
(INSPECTOR)
PLEASE FAX TO CITY OF SPOKANE VALLEY UPON COMPLETION (509)688-0037
Effective October 28, 2007
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