2015, 05-28 Permit App: ROW-2015-0299 Water Service Line05/28/2015 16:51 5099249084
Sp 1 ne
. Valley.
Community .Development
ROW Construction
Permit Application
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
perm iteenter(cA,spokaucval ley.org
IRVIN WATER DISTRICT PAGE 02
PERMIT NUMBER:
PERMIT FEE:
❑ Driveway EfPavelment Cut **(see below)
0 Sidewalk ❑ Curb & Gutter ❑ Other
Road Obstruction ❑ No Yes (traffic control plan required)
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START DATE Junes ), a015
Building Owner:
Name:
ANTICIPATED COMPLETION DATE jon� ) J cg®)J�'
Contractor: tr\jyr� y��r�-4r^ (� �-
Name:
Address: Hx-1,Q4, E Ernpoi «.'
City: tate: Zip:
Phone: Fax:
Contact Person
Name:
Phone:
**MUST BE COMPLETE IF PAVEMENT CUT**
•Address: I q 7 p. ,o,
U State: \ pt
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Phone:1
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Contractor Lie No:
Exp Date:
City Business T,ic. No:
Tier
Policy
TVPe Qf Work
Gas
E ectric
Water
CATV
CQndL ion of Cut
CSawcut
Grind (pre—approved only)
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Communications
Sewer
Other
Type (Repair Existing.Road Condition
As halt Depth of Asphalt • /
Concrete cpt o ravel
Asphalt.
Width Length
X.
Concrete
Width Length
X
X
X
Locate Ticket # ±ter- li ettpQ 1r,
BOND/INSURANCE CERT #) ng73 1p
Signature 3A,44.-4.) Date
(PER SVMC TIT IFE—ie-ARTICLE 2)
RECEIVED
CSV PERMIT (,.'ENTER
Method of Payment:
❑ Cash
Bankcard #:
Authorized Signature:
Work completed satisfactorily,
❑ Check
❑ Mastercard
Expires:
aevmn n,orearoe
(INSPECTOR)
PLEASE FAX TO CITY OF SPOKANE VALLEY UPON COMPLETION (509)688-0037
❑ VISA MAY 2 8 2015
VIN#: )Project # Rate .--70 lc– Z (Y
!Name
Submittal #
Date
Received Time May,28. 2015 2:41PM No.1932
05/28/2015 16:51 5099249084
Fax Transmittal Form
IRVIN WATER DISTRICT PAGE 01
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g Irvin Water District #6
11907 E Trent Avenue
Spokane Valley WA 99206
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Name: G�...vpekarVc e..5 f 'n1'i--1
Organization Name/Dept: Ceyri-ex
CC:
Phone number:
Fax number: 4.345(37
Urgent
For Review
Please Comment
Please Reply
From
Gig • l_r-ry
Phone: 509-9249320
Fax: 509-924-9084
Date sent:
Time sent: ,G:'4 LJ
Number of pages including cover page:
Message:
1 c J C Ve(ny6-sr- i).p1 iecchio 1,
Received Time May.28. 2015 2:41PM No.1932
TYPE III
BARRICADE
TYPE III
BARRICADE
RECEIVED
CSV.PERi IPTCFNTER
StILAY 2
Project # W 2015
aa' Name 7 9
Submittal '#
IQ TEMPORARY SIGN LOCATION
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200 - 350'
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TYPE III
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Projact # L2_42.8� 0-2q6/
Name 1775
Submittal
NOTES:
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2. ALL SIGNS ARE BLACK ON ORANGE.
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P. 1
* * * Communication Result Report ( May. 29. 2015 9:01AM ) * * *
1) Spokane Valley Permit Center
2)
Date/Time: May. 29. 2015 .9:00AM
File Page
No. Mode Destination Pg(s) Result Not Sent
1937 Memory TX 99249084 P. 3 OK
Reason for error
E. 1) Hang up or line fail
E. 3) No an swe r
E. 5) Exceeded max. E-mail size
E. 2) Busy
E. 4) No facsimile connect ion
City of Spokane Valley
Community Development
11707 E. Sprague Ave., Suite 105
Spokane Valley, WA 99206
(509) 720-5240
permilcenterdXspakenevelley.org
ROW -2015-0299 DE -ROW
PROJECT NAME: ISSUED: 0812912010
SITE ADDRESS: 11426 E EMPIRE AVE SPOKANE VALLEY EXPIRES:
PROJECT DESCRIPTION: REPLACE WATER SERVICE LINE
PARCEL 45043.0905
APPLICANT: IRVIN WATER DISTRICT -INVOICE
71907 E TRENT AVE SPOKANE, WAOO206
OWNER: IRVIN WATER DISTRICT -INVOICE
11907E TRENT AVE
SPOKANE, WA99200
FEES: Paid Duo
Right of Way 8168.00
Trials : 9166.00
CONDITIONS
• ' The traffic control pion submitted has been opproved for concept only. The Contractor 0 responsible for determining
specific signage and layout as required by the Manual on Uniform Traffic Central Devices (MUTCD). WSDOT specll kation
and Washington State i00010e0ona to the MUTCD. All devloea eha0 oonform to the MUTCD and WSDOT specifications.
For all permits that include road obstruction the Contractor shall notify the Spokane Valley Public Information Officer (PIO)
at 5119.7201411 within 24 hours of receiving tin approval. For any changes to he schedule of the road obstruction Ore
Contractor shall notify me PIO of tae change with a minimum of 46 hour notice paw to the road obstruction. The Contractor
shag provide the location of the work, expected start and end limes and dates of the road obslnrclion. The PIO vdfi notfy the
newspaper, school districts, Spokane Valley Police Daparknenl, or fire dispatch as necessary.
The City of Spokane Valley may request changes as warranted by traffic condition and motorist behavior.
• lithe construction sone is open to traffic beton: completion of final paving the Contractor shall provide warning signs- es
required by the MUTCD and WSDOT specifications:
• WSDOT Wal 2oneTraffic Control Guidelines are available at www.wsdot.wa.gov. For future submitlafs, please use the
Mork Zone Traffic Control Plans (TC-1—TC-18) If applicable to your project.
• Prior to excavation, It Is the Contractor responsibility to contact the purveyor of any transmission pipeline that is w0Nn 100
feet of permitted work, as per RCW 19.122.033.
• ` For pavement cuts. es -buil) drawings (using the cuaent Inland Northwest Regional Pavement Cut Policy template) are
required to be submitted to the Right -of -Way Inspector, Scott Wallace, within 15 working days of wok being completed. As -
befits shall be submitted by email (to swellace@spolanevalley.org), by Fax (5099211008) or by dropping of at the Pernik
Center.
• ' Al pavement cuts within the Cly of Spokane Valley nght-of-way shag comply VA1h the current adopted Inland Northwest
Reginal Pavement Cut Policy, or as emended
Au pavement repairs shag be Inspected by the Calls ROW Inspector. Scott Wallace (mobile: 5098805.973). The
Contractor shag notify Mr. Wallace a minimum o124 hours in advance of the posing.
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