2006, 10-31 Permit App: 06004298 ROW, Relocate Power Supply09/27/2014 18 19 FAX
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Call 24 hours before iafpeetibo requited
Phone 509,688-0195 Fax 509.658.9037
DEPARTMENT OF PUBLIC WORKS
12 001/001
Anticipated start data /O - 3 / — {o Permit #
ROW CONSTRUCTION PERMIT
Location of property
4' Fe/ f5 ted.
Applicant Name SCF/! �� (AddreeslPa real Y, if aysF o) ox 509 • J 2 - 8S/c
Address 007 e. Tf2en-fl Phone 909- 63;- g-5 08
Contractors Nome e --C1 "'t e. / Q--,-, e--' x.
Address Phone
Contractors Reg.#50fAlC.r4-195'wa 7 Expires
pRDJECT DgSCRIPTIOb( (provide sibs sketch or plan as necessarytorclarity)
_ Sewer Connection ❑ Driveway
❑ Curt & Gutter ❑ Oa Installation/Repair
Ft Cable/Conduit/Pole ❑ Sidewalk Repair/Constriction
❑ Water lristatlabordRepair n Other
' 0 Pavement Cut
Dimensions
Bond/InsuranucarUncaUpn must be on fila %nth the Ch . Bond Y
SPECIAL CONDITIONS`
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PermttteeSignature L -f' Approved
Date
1 hereby maths Ihetlfy or Spokane Valley to charge the fee for this prank to my aedk cord.
Card #
Nerve of holder
Sloneture
Explratton Data
Faros Paid$ Date Init
(Application) (Inspection)
In addition to the permit application foe of risco (utility) or 126.00 (ecnatrucllon). Inspection on
each permit will be bllted to the pentlitte° at n rate of $50,00 per hour with a 525.00 (1/2 hour)
minimum. Pemtllteeslgnature constitutes an agreement to these terms and provisions.
Work completed satisfactorily (Signed) Oats -7 p
Permit not valid until One -Call Notification Ticket # entered here (C13 7 [ Q
PERMIT MUST 2E KEPT ON SITE
OCT 26 2006 11:28
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PRGE.01