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2014, 11-07 Permit App: ROW-2014-0646 ROW*po ne ey• bbbl '°N WdSE: blob '9 Community Development Department Permit Center 11703 East Sprague Avenue, Suite B-3 Spokane Valley, WA 99206 Tel: (509) 688-0036 Fax: (509) 688-0037 perm] tcenter(a1 sooka neva I lev.orq AoN ami' paAiaoaH (Staff Use Only) PERMIT NUMBER: PERMIT FEE: RIGHT OF WAY (ROW) PERMIT APPLICATION APPROACH CURB & GUTTER PAVEMENT CUT (SEE BELOW) ' WORK THROUGH MANHOLE t SIDEWALK OTHER ROAD OBSTRUCTIONNO DYES (if yes, complete the following) TTTT • % of street or # lanes that will be obstructed: • Length of time street will be obstructed: c 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 Pre -Approved TCP Proposed: PROJECT ADDRESS: /7loDS E eztaz APPLICANT'S JOB #: / Z 5-3 (f Lz- (1_,CiQ PARCEL NUMBER: LOCATE TICKET # START DATE: //1/40/r y PROJECT DESCRIPTION• � ANTICIPATED COMPLETION DATE: /7/24,// r2L� p 14-c0Q 5 L:(,L_tie./ d,q lao PROPERTY OR BUILDING OWNER INFORMATION (IF APPLICABLE) NAME: MAILING ADDRESS: CITY: STATE: ZIP: PHONE: FAX: CELL: CONTRACTOR INFORMATION €90 Kit L5rj -r(_.±4- ' CA -MC. t MAILING ADDRESS: Po 6 ay_ (a Z( 9 CITY: 5190 Rfr Ai F PHONE: j '3399 t- 3 /Z.-77_ NAME: CONTRACTOR LICENSE NO.: 5 fO y:, 4'Dab 9q L Cr. STATE: t 4_ ZIP: 99ai 7 FAX: 6o') cin -2- CELL: EXPIRES: 3/, 5/1 s CITY BUSINESS LICENSE NO.: BOND/INSURANCE CERTIFICATE # (per SVMC Title 10, Article 2): CONTACT NAME: U1 2 t I 1.-(.0 >2- N S. f(LL PHONE: So r — Ljy3 --it 7 z... Project## I' --'alt . G 616 6 RECEIVED � NOV 'J 0 7 2014 RSV PPPIIAIT r wnrTFp Modified April 14, 2014 Page 1 of 2 httD://www.sookanevallev.oro/filestorage/124/938/210/948515 ,283LRQW p .d c Ev.. # T00131 AAIIVA F VIflVD ONV IIO.TTO H\'VNOJS SZCZC8660S WA 6g:LT 6T0a/90/TTm **** IF P NATURE OF WORK: (circle one) TYPE OF CUT/REPAIR: (circle one) SIZE OF CUT (width) x (length) STAFF TO COMPLETE: ROAD TIER:_ VE Gas ENT CUT • COMPLETE T Electric Water CATV *HI'°N WdSE b blob '9 'AAN awil paAlaaaa FOLLOWING **** Communication Sewer Asphalt Gravel Concrete Other PAVEMENT CUT POLICY APPLIES? Other DISCLAIMER The permitted verifies, acknowledges and agrees by their signature that: 1) If this permit Is for construction owner.perty 3)Thedwelling, signatoryli ,he dwelling tellproperty be served hasby potable water. p ownership of this Coity of wner Inokane thistranslley action. 41) Inures All constructions to be done infull compliance with the Clty of oVpermission to rnt code. the property Spokane Valley Development code. Referenced codes are available for review at the Clty of Spokane Valley Permit Center. 5) The Clty of nrorrmatlon imay berrequiredtta o pemit or approval for and subsequently approved before this application can tion of federal, state or local laws, ordinances. 6) Plans or additional can be processed. EXPIRATION 30 days extension availlaablel. Right-of-way permits Issued betwd een Octobetember r 1a and Marchr31'r are valid ountil the followingiAprII30tth a one-time 30 -day Applicant Signature: Date: Method of payment: 0 Cash 0 Check Ly Isa** ❑ 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 1 • Inn' 4 A W7'1VA F A'Tnvn rtMV ff'1.TTn IMVvn,JC •4: 496 OW Page 2 of 2 C7Q7PAtAne i'V.d Re:/.T VTfZ/An/TT