2006, 01-31 Permit App: 06000273 Emergency Repair Water Main01/19/22CE 11:45
5097E59c00
MAR 25 2003 13:07 FR
City of
SPOKANE VALLEY
UTfLITY RIGI-IT - OF -- WAY APPLICATION
AND PERMIT
PUBLIC WORKS DEPARTMENT
APPLICATION
M U L)CrC14
TO 7359000
'P.02/02
oa-1 3
0o
PRIUvILT i pw
Lr>cililoli tlf property involved (or address) it/qo Fl E//?L p
Mime of coiiijiaiiy± Pow: t- ciR I .Vf TJ= ' l Ptif't LLY
AtIthrzs of companyTO1 F, S[1_0M' LV ULYt_WJl C!9/I`L [,hone 1C:r-6I5110
('ittriictor6 tittnic
Contractors Jtictress
Contrnctors registrs7tion Number
Right of Wily:
Pavranent or rltkwi1k intrusive. Yes ✓ No
Intrusive outside of part:meta or Aide -walks. Ycs No
I,en th of cut /( ft, Depth of cut Y ft. TV141th of cut (r, ft.
phone
Eipiration tInfc
Direction of cut
�
ContAct p.erst;
ul ��!/1 /J T/,�rf,/,..vs `✓
A.ddrr_ta of colltiid't
1'tl(111C
��. r Ck_ Gr p lir
Vlensc philn fire det.til the description of the ;lct_ivity propocecl_'�1��L G ,✓Cy����!/l
1 bcrciry •uthottze the Ctty of Sp61.-il►e Valley iu as the fra for tlii9 venni( I my crvdll cir4_
119/1 ?1>titrcct]j1r.r
i'tut a 11ne t>( Iri,lile, `signature
I'I�YZ111(7�= Special Conchtinns
Rettoration: Pram ne_rt 'I'unpiwary
Type, n( back fill to he gravel crysit /41 - CDT'
ISA COPY OF A liONt) I)EPOSrrat) «Tit[ TILE CITY OF SPOKANE VA ILLI; Y 7
A COPY OP rat, CITY / TTrl fir Y LIABILITY INSURA NCE POLICY MUST EC ON
/FILE AT TIT!: CIT V`.
-1'1r,E2 11'1' FEL:
:1pprovit1
INSPECTION EE -E S
E'uhlic SVorks 11irectr.>r
A- r i - v,• .� 1 !'.
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C_',t_1.;I 24 ILO t IK',S' I;.L F(I RE INSPECTION NC'ti7)E.l D
17tr>nc 509-C>hd'-003 Fax 509-6Ss•-Oo3
cam. TOTLL Pte.. )
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