2004, 04-19 Permit: ROW04-242 ROWSp61
Valley
Call 24 hours betbre inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date Permit # 04-242 Account #
ROW CONSTRUCTION PERMIT
Location of property 1303 S. Custer Rd.
(Address/Parcel #, if available)
Applicant Name Lindsey Construction Fax
Address P.O. Box 30792 Spokane, Wa. 99223
Phone 509-879-3420
Contractor's Name
Address Phone
Contractor's Reg.# LINDSCI066OW Expires
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
Sewer Connection ■ Driveway
El Curb & Gutter El Gas Installation/Repair
n Cable/Conduit/Pole ❑ Sidewalk Repair/Construction
n Water Installation/Repair ❑ Other
nPavement Cut Dimensions
Bond/insurance certification must be on file with the City. Bond #
SPECIAL CONDITIONS: Construct driveway approach per Spokane County Standards as
adopted by the City of Spokane Valley.
See attached Provisions
Permittee Signature Approved Date '---74 -
l9 O
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card # Expiration Date
Name of Holder Si
nature
Fees Paid$ 25.00 25.00
Date
!nit
(Application) (Inspection)
In addition to the permit application fee of $16.00 (utility) or $25.00 (construction), inspection on
each permit will be billed to the permittee ata rate of $50.00 per hour with a $25.00 (1/2 hour)
minimum. Permittee signature constitutes an agreement to these terms and provisions.
Work completed satisfactorily (Signed)
Date
Permit not valid until One -Call Notification Ticket # entered here
PERMIT MUST BE KEPT ON SITE