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2004, 12-28 Permit: 04009519 Water Installation61 Spokane � . Valley BUILDING DIVISION 11707 E Sprague Avenue Suite 106 Spokane Valley, WA 99206 Site Information Project Information Site Address: 9900 E BROADWAY AVF, Parcel Number: 99999.0000 Subdivision: Block: Lot: Zoning: UNK Unknown Owner: CSV -ROW Address: BROADWAY & WALNUT SPOKANE VALLEY, WA 99206 Building inspector. KEVIN SEVERANCE Water Dist: Project Number: 04009519 Inv: 1 issue Date: 12/28/2004 Permit Use: WATER INSTALLATION/10' SIDEWALK AND CURB CUT Applicant: VIETZKE EXCAVATING 2011 S CRAIG RD AIRWAY HEIGHTS, WA 99001 Phone: (509) 244-9607 Contact: VIETZKE EXCAVATING 2011 S CRAIG RD AIRWAY HEIGHTS, WA 99001 Phone: (509) 244-9607 Setbacks - Front: Left: • Right: Rear: Group Name: Project Name: ROW Permits Right of Wav Contractor: VIETZKE EXCAVATING License #: VIETZECI2IMA CONST IN ROW - UTILITIES FOR RIGHT OF WAY INSPECTIONS CALI, (509) 869-5373 ENGINEERING 1 S16.00 ROW INSPECTION . Total Permit Fee: 1 $25.00 541.00 Payment Summary Total Fees AmountPaid AmountOsving $0.00 $41.00 $41.00 Tran Date 12/28/2004 Receipt # Payment Amt 6206 $4100 Notes / Conditions of Approval PERMANENT ASPHALT PATCH PER PROVISIONS FOR C OF 0, OR CASH BOND OF $5000.00 PER K SEVERANCE Processed By: DOMPIER, DAWN Printed By: MIKE TURBAK Page 1 of 1 PERMIT