2015, 02-26 Permit: ROW-2015-0089 Right of WaySpokane
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
PermItcentera5Dokanvallev,oln
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
RIGHT OF WAY ROW PERMIT APPLICATION
APPROACH
CURB & GUTTER 0
PAVEMENT CUT (SEE BELOW)
WORK THROUGH MANHOLE
SIDEWALK
OTHER
ROAD OBSTRUCTION NI NO 0 YES (If yes, complete the following)
90,Aiaer Waek • % of street or # lanes that will be obstructed:
• Length of time street will be obstructed:
(::;5 If work closes more than 50% of a local access street, or closes any portion of an arterial street,
then a TRAFFIC PLAN IS REQUIRED El Pre -Approved TCP Proposed:
PROJECT ADDRESS: /7 '!2 6 /9/k; Ave PARCEL NUMBER:
APPLICANT'S JOB #: /9530S
START DATE: 3 - „ID'S
PROJECT DESCRIPTION:
plaa (i'c.1
LOCATE TICKET #
ANTICIPATED COMPLETION DATE: 3 7
6,bie o
J,i- /de
PROPERTY OR BUILDING OWNER INFORMATION (IF APPLICABLE)
NAME:
MAILING ADDRESS:
PHONE:
CITY:
STATE: ZIP:
FAX CELL:
CONTRACTOR INFORMATION 13
NAME: -€f0 n co. 4-;0/1
MAILING ADDRESS: 30)(1 N,
t
6A
p...E: 509 - 532 -
60 VicZi
CONTRACTOR LICENSE NO.:
CITY: ...5pfa#i
FAX 5o - S3.2 es) s
EXPIRES:
STATE:
ZIP:
CELL:
CITY BUSINESS LICENSE NO.:
5C
BOND/INSURANCE CERTIFICATE # (per SVMC Title 10, Article 2_):
CONTACT NAME / c?cf3rennc. r
PHONE: .20.L. 71 57
•
F
itaoc-c.
Modified April 14, 2014
http://www.spokanevalley.orciffilestora_g_eLl24/93_81210/9_4_13/1496/2831/ROWPA,doc
Page 1 of 2
**** IF PAVEMENT CUT, COMPLETE THE FOLLOWING ****
NATURE OF WORK:
(circle one)
Gas
Electric
Water
CATV
Communication
Sewer
Other
TYPE OF CUT/REPAIR:
(circle one)
Asphalt
Gravel
Concrete
Other
SIZE OF CUT
(width) x (length)
STAFF TO COMPLETE:
ROAD TIER: PAVEMENT CUT POLICY APPLIES?
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) If this permit Is for construction or on a dwelling, the dwelling Is/wIll
be served by potable water. 2) Ownership of this City of Spokane Valley permit Inures to the property owner. 3) The signatory Is the property
owner or has permission to represent the property owner In this transaction. 4) All construction Is to be done In full compliance with the City of
Spokane Valley Development code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit Is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
Information may be required to be submitted and subsequently approved before this application can be processed.
EXPIRATION
Right-of-way permits Issued between April 1st and September 30"' are valid for 30 days after the date of Issuance, with a one-time 30 -day
extension available. Right-of-way permits issued between October lu and March 31t1 are valid until the following April 30`".
Applicant Signatu
Date:
Method of payment: ❑ Cash 0 Check 0 Visa** 0 Mastercard**
** If paying with credit card, the City will call for credit card Information when the permit Is ready to be issued.
PLEASE FAX TO CITY OF SPOKANE VALLEY (509) 688-0037 UPON COMPLETION
Modified April 14, 2014
Page2of2
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BUFFER DATA
LONGITUDINAL BUFFER SPACE
72.EE2 7f4P.1 25
L,CMG-171 Ueotli 15S
33
35
13
45
SON SPACING - X (�I) ( 1 I
1 r; RURAL ROADS & URBAN ARTERIALS 35 /40 MN I57I
•:! , RURAL ROADS, URBAN ARTERIALS
i RESIDENTIAL a Busmen oisriecia 2"3° MPH MC* all
I URBAN Si 25 MPH OR LESS 1031 123,
1ITTI7r.,7!
20a
750
305
- - -
Proxik. *thick! norrnntended .1111 be a work ratiele If a ISIA 4 roc
6v1610640.0•• 0,0069,6 %.61.4564 %NO oe straIntary Imam al ON 500 02
tPrI.1 waken an0 ra5 road dadarco0 10o04e0
I 44.1. SIGNS ARE ar 4E BLACK ON ORANGE UNLESS 0714ERWISE
1 DESIGNATED
AN spacing may be adjusted to accommodate interchange ramps.
at -grade Intersections, and driveways.
(2) This spacing may be reduced in urban areas to St roadway
conditions.
LEGEND
000
CM:1
W21.5
SIGN LOCATION
CHANNEUZING DEVICES
PROTECTIVE VEHICLE - RECOMMENDED
2r-
5:51 2' tiu.
"Mr, n er
17, er""trt- f)
MID
-r
wORI( AREAV,,7
,177
M p.....:±471
MINIMUM TAPER LENGTH T 1 14660
..
S000:10! 1 Ptsled Spew (ml)
MO /bap 2s 30 35 40 45 50 55 60 65
30
a 1 ea I, 52011621 210
- 1 - i .. I • 1 - 1
•
la I 5 1 2
- , - I • I - 1
3 DEVICES M0415.6/61 SPAC430 100.0.IN TAPERS FOR
SHOULDER YNOTIIS LESS IsWe e FEET
3HANNEUZONG DEVICE 55
TAPER
40
60
25
/
20
NOTES
1. Protective vetecie recommended - may be a work veniee,
2. When used. device spacing ase the downstream taper should be 25*O.C.
TYPICAL SHOULDER CLOSURE - LOW SPEED (40 MPH OR LESS)
TCP 5
CO
SallOZ 31.10M