2014, 10-30 Permit App: ROW-2014-0630OM :
HAWKINS EXCAVATING PHONE.NO. : 924 9025 Oct. 27 2014 07:57AM P1
Community`Development Department
Permit Center
SpdFa—ne
11703 East Sprague Avenue, Suite B-3 (Staff Use Only)
Spokane Valley, WA 99206 PERMIT NuM6ER:
Tel: (509) 688-0036
1„ Fax: (509) 688-0037 PeRmxr Fee;
l�
er I tce n te rr& s n o kv e
RIGHT OF WAY ROW PERMIT AP
h DRIVEWAY
CURB & GUTTER
PAVEMENT CUT (SEE BELOW)
OTHER
ROAD OBSTRUCTION NO
PROJECT ADDR
START DATE:
10-29,- /
'BUILDING OWNER NAME:
NAME:
Z YES ***
ANTICIPATED COMP
M-101
SIDEWALK
OCT 3 0 .2014 '
AFFIC PLAN REQUIRED
CSV PERMIT CENTER
ADDRESS:
$ O S- 6Z
Cha C
GVTC^1rTJ► Tw. &,
Depth of Asphalt:
CITY:
s�D/�cz�/
STATE: �,
-
ZIP; y
PHONE: FAX:
CELL:
CONTACT NAME:
PHONE: FAX:
CELL:
CONTRACTOR NAME: 1. �la�.r✓�i,c/S`�'�
MAILING ADDRESS: / /�' Zz
CITY: S�Q/�Lp iJ/ P STATE: ZIP. Q
PHONE: y JPd __7 <- FAX: /2 �DL'z CELL:
CONTRACTOR LICENSE NO.: �1,je EXPIRES: =�/-/ ,� CITY BUSINESS LICENSE NO..-
TIER:
O.:
TIER:
POLICY:
BOND INSURANCE CERTIFICATE #:
(PER SVMC TITLE 10 ARTICLE -2)
SIGNATURE:
DATE: /e,) - -? T-/ L/
****MUST BE COMPLETE IF PAVEMENT CUT****
TYPE OF WORK
Gas
rnNnTTTnM AR r]IT
Sawcut
TYPE OF
Asphalt
GVTC^1rTJ► Tw. &,
Depth of Asphalt:
Electric
Grind
rea roved only)
Concrete
Depth of Gravel:
Water
CATV
Comm.
Sewer
Other
Effective October 28, 2007 Page i of 2
Re c e i v e d T i m e'vOc t, 27. 'L'20 14 6: 2 8 AV`N 0. 1 6 �38/210/948/1496/Right of Way_(ROw)_Permit�pp_1-11-11-Goc
FROM : HAWKINS EXCAVATING PHONE NO. : 924 9025 Oct. 27 2014 07:58AM P2
Asphalt (width x length) Concrete (width x length) Locate Ticket #:
x x x
x x x
x x x
x x x
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: i) If this permit Is for construction or on a dwelling, the dwelling ls/will
be served try potable water. 2) Ownership of this City of Spokane valley permit Inure 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 Ctty 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.
Signature Date:
PLEASE FAX TO CITY OF SPOKANE VALLEY (509) 688-0037 UPON COMPLETION
4) / Al 4i 4-'0? D iv e G -tj e tet/ 7,0'Q e 6Y
Effective October 26, 2007 page 2
httD://www.sookanevaIlev_oro/filestoraoe/124/938/210/94S/1496/Right_of Way_(ROW) P@rmlt_App_i-1!-Ii.doc
Received Time Oct.27. 2014 6:28AM No,1160