2013, 05-22 Permit App: ROW-2013-0258 ROW,. Milley.
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite 8-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter@spokanevallev.erg
(Staff Use Only)
PERMIT NUMBER: W� O e)S-lb
PERMIT FEE:
RIGHT OF WAY ROW PERMIT APPLICATION
0 DRIVEWAY 0 PAVEMENT CUT (SEE BELOW) 0 SIDEWALK
0 CURB & GUTTER /2 OTHER
ROAD OBSTRUCTION tir NO 0 YES ***TRAFFIC PLAN REQUIRED
PROJECT ADDRESS: /022 C 2I rd �ib Z),� t_rt,e, Val/e i Wfr
STJART DATE: 5-.4 .13 ANTICIPATED COMPLETION DATE: 67.13
KID -DING OWNER NAME: Lori et/ F7OrrS j 0?,)a •
NAI4E:
ADIDRESS:
Cz(rv:
andLi �/-2� �F re_53'`�
�1 v(•�.,�. STATE: I•
PHONE: /14
C(IINTACT NAME: S C () l.�/ ,SCS //
FAX:
CELL:
ZIP: 61g21)LP
Nf14
CONTRACTOR NAME:)/edelec Fj?'r)
rises/rc•nba
S Lir- of
MAILING ADDRESS: p•p • Bt 3 / 1 croa_S8 5 =-0
C!rry Deer .j4! / STATE: MX
�% A n (/j}�J ��// ^ %^ ZIP: q , D L
PHONE: 5 V / L L 23� I FAX( j� ' 4'7 W� CELL: 5t/-/ [ LO �.tJ 4/304-
CONTRACTR N
OLICENSE o.: -( E7C' : CITY BUSINESS1'
1/ � LICENSE NO.: w, � � au
ZELY:
"
1,3OND/INSURANCE CERTI I
;PER SVMC TITLE 10 ARTICLE 2)
(SIGNATURE:
_;a4.itratv
bL�C,J, • F'=S3t.'a 7%13
)t DATE: .. 14. 13
****MUST BE COMPLETE IF PAVEMENT CUT****
TYPE OF WORK
CONDITION OF CUT
TYPE OF
REPAIR
EXISTING ROAD CONDITION
Gas
Sawcut
Asphalt
Concrete
Depth of Asphalt:
Depth of Gravel:
Electric
Grind
(preapproved only)
Water
CATV
.,_
Comm.
.- ani -Qa:
Sewer
Other