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2015, 04-16 Permit App: ROW-2015-0175 ROWSpole .' alley. 9bLL '°N Wd6l Community Development Department Permit Center 11703 East Sprague Avenue, Suite B-3 Spokane Valley, WA 99206 Tel: (509) 688-0036 Fax: (509) 688-0037 permitcenter@sookanevallev orq Zl(°rl-0b 9-1 'ady 9w_1_Pa !E121 (Staff iUseOrily)t— CSV PERMIT CENTER PERMIT NUMBER: +2 APR I & 2915 PERMIT FEE: I' 1 Pro ect # f V c(Jfs J Ni LamI' Name moi% fTi I SubmittalTI RIGHT OF WAY (ROW) PERMIT APPLICATION El APPROACH El PAVEMENT CUT (SEE BELOW) SIDEWALK El CURB & GUTTER n WORK THROUGH MANHOLE I OTHER ROAD OBSTRUCTION JAL NO 0 YES (if yes, complete the following) • % of street or # lanes that will be obstructed: _ • • Length of time street will be obstructed: b 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 "SII Pre -Approved TCP Proposed: PROJECT ADDRESS: g.,Q) O. /2g_ PARCEL NUMBER: APPLICANT'S JOB #: / So 7 a- 3 9 S LOCATE TICKET # START DATE: 11/02.0 // 5 ANTICIPATED COMPLETION DATE: 9/2, 5// S PROJECT DES/�CRIPTION: d g20 s - &A.,7,4_, LA fit_4 en A, e-6--t-ia_ �,- t, I C1 PROPERTY OR BUILDING OWNER INFORMATION (IF APPLICABLE) NAME: MAILING ADDRESS: CITY: STATE: ZIP: PHONE: FAX: CELL: CONTRACTOR INFORMATION NAME: epo K.A'l.:1F I iTCt-I- CAr—!3L_te -L,G— MAILING ADDRESS: (Q 3 INC(p ZI 1 CITY: PHONE:. ) ! 56,_ yips JZ -72 FAX: apo K/-ru F 60r—YP3-zs -s STATE: LLj4—. ZIP: Cj / z 17 CELL: CONTRACTOR LICENSE NO.: SfbKR Ik'O el9 LC EXPIRES: ,3// 5// 5 BOND/INSURANCE CERTIFICATE # (per SVMC Title 10, Article 2): CITY BUSINESS LICENSE NO.: CONTACT NAME: ()t cl -LC 12-6-1£42_. PHONE: 5°9 —4123 —it 7'Z... Modified April 14, 2014 htto://www. sookanevaliev.org/filestoraee/124/938/210/948/1496/2831/ROW PA.doc rnn Ffi T'J'f'TWA 4- v'iavfl maw onT Trt :TkTNVnJC Page 1 of 2 c7c7coaane ae❑ JO:CT crroioTibn 9tLl °N Wd6l dl SLOZ '9L 'AV awil paAialay **** 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 thls 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 30th 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 1* and March 3Ist are valid until the following AprII 30th. Applicant Signature: Date: Method of payment: 0 Cash 0 Check 'Isa** 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 COMPLETIOI Modified April 14, 2014 htto://www.spokanevallemm/illestoraueD 24L4.3B/210/946/ 1496/2831/ROW PA.doc Inn FRi Page 2 of 2 a-,aan akar afTra vknrvnJc n7e7voaane VVJ ,c•CT CTroioTian 917Ll '°N Wd6l:1 SL@ '9l 'ady anvil pane, anaa 4i/g.0 746-16 • $09 %a? 318'0 Iv e.„50.. Crk S09 &CA ir37 F720 -> Et,,,ra 1 L1 bbl, en n FM Lark 1410 Ave - Ors \o Dr lye. Te Lit/ /i gpJ sec.6 673 r� S_�� opecci I„Ne_, plac ,-leo." Gk, 37t �harN b 4 v r/tL,e. p - z .G° WTI -F 3 s S&) /oma Tn rt c, 4s eSs;IJ,c 7S# (507239S TZfl1a1A a vnavn nkni unTIn mvunic c7e,eosane VV., oc:cr CTn7,0r,,,n