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2014, 10-28 Permit App: ROW-2014-0615SrAkane .000Valley- Community Development Department Permit Center 11703 East Sprague Avenue, Suite B-3 Spokane Valley, WA 99206 Tel: (609)-688.4996 • 6-001-'720- $.2•4" Fax: (509) 688-0037 De rmItcenterfdlsooka nevatlev.orq (Stas &JeL % if PERMIT NUMBER: PERMiWE:PFPMIT CENTEf Ux- RIGHT OF WAY (ROW) PERMIT APPLICATIO RE\/ DRIVEWAY PAVEMENT CUT (SEE BELOW) f SIDEWALK• CURB & GUTTER OTHER ROAD OBSTRUCTION '¢ NO YES ***TRAFFIC PLAN REQUIRED PROJECT ADDRESS: W2,/ W A-V G'T •�r ever- .Tda 14/.93/S4' START DATE: /1 /c/%/ SG ANTICIPATED COMPLETION DATE: ///4//4" BUILDING OWNER NAME: NAME: e,rLRS? D F kkS tl tJA 72) v ADDRESS: 66/D t/A"GGE Y A-!/& JJG.7 BG Z.' -TO /2. CITY: 711.c V /3-LL..Lt D STATE: LOA PHONE: 253 S(o tf L-/ 3 / FAX: CELL: ZIP: 9837 3 Z55 73(,- 3257 CONTACT NAME: 70E yiiv?Z./s PHONE: Z53 ,g 33 / FAX: CELL: CONTRACTOR NAME: /,t1GE -7214e-a4,44 u_y+ .2g..41.)t.,V_6.,oGSD,t/ MAILING ADDRESS: /370 / L4Ct4 57 A ;3G `G ' Cm: _3[r m PHONE: 25 ...3 G I/' ZS % Z ad STATE: p/a, 4- FAX: 24.r33 2 / PZ !TT ZIP: QD91'3 / b CELL: /- !4 Aef 2 CONTRACTOR LICENSE NO.: ahtj& y j 59 kJ} EXPIRES: -l/ //sS° CITY BUSINESS LICENSE NO.: LLV - % i%4VVZ. TIER: POLICY: BOND/INSURANCE CERTIFICATE #: (PER SVMC TIT RTICLE 2) SIGNATURE: / DATE: /0 /a-trArC.. ****MUST BE COMPLETE IF PAVEMENT CUT**** TYPE OF WORK CONDITION OF CUT TYPE OF REPAIR EXISTING ROAD CONDITION Gas Sawcut Asphalt Depth of Asphalt: Electric Grind (preapproved only) Concrete Depth of Gravel: Water .-e444Aza, JIAJAAt. , (N -(,t /6-12. CATV A �: f ;r�i✓ 4. Pif ✓, , co-ii/L_ Comm. Sewer • Other Effective October 28, 2007 • r•Nrl/1rt imanhe a net Cntlinne\n..M111M.en... ..s r•_-1.-_-.r-.r_.. ....... _._._.• .• Page 1 -of 2 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: 1) l this permit Is for construction or on a dwelling, the dwelling Is/will be served by 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 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 perml 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 (/1 � ��G.%L. Date: /jJ�,Le�, Method of payme t ❑ Cash 0 Check 0 Visa 0 Mastercard Bankcard #: EXP: VIN#: Authorized Signature: PLEASE FAX TO CITY OF SPOKANE VALLEY (509) 688-0037 UPON COMPLETION © Pe -A) i73' uu,/ is' , 2/1e, f 041 z" Au e_., 3/et) r64 -7-I Pe -7J Lv0.4-7 L) A--#0): /s' .06 z -r oP D,ebg, 2 F '4'/5 /zaZ / c5. C , 4J5 WA-' G'' T. ' P,eoe a a -rte 7D Pr- 7- Fig 2 1 Pz. 9 ~ fz .5 i,,04',J7 L 6,0 A) B -7xez/ Ss a /GG/i G[)4Y AT: Effective October 28, 2007 Page 2 of 2 ('r\nnri,mpntc And CPttinneNnunn7 M.. ri.,n.•menrv%oe..,,W..A.,a e... I.,... % u .. nnW __ u__.r-- '-- 6.7 w a w Figure 6H-1. Work Beyond the Shoulder(7A-1) A Note: See Tables 88.2 and 6H-3 for the meaning of the symbols and+or tatter codes used in this figura. Typical Application 1 Image- capture- Scp 2011 2014 Gooq