2005, 03-03 Permit App: 05000684 Street ObstructionMAR -03-05 THU 02:44 PM A
5099283474 P.01
APR 00 2003 14110 FR TO 9283474 P.01/02
City of PERMIT # PWl I
SPOKANE VALLEY
Unfit RIC}HT — OP — WAY APPLICATION AND PERMIT
PUDL.TC;van S DEPARTMENT Date project starts
.Date Project ends 3- 9- O -
APPLICATION
Location of property involved (or Address) ) / O . 4j; 3t\ fevvi r '
Nagle of company J i 'rc. Cc 1S�C\kC\`01'\ -
Address of company jk-DS) N' -11e.\-Aly \ 'Illphone \fib— aa.M3
Contractors Untue DC1,1L1\A��
Coutrectors nddxess__, e(1.1't1t, phone q -Lb 'D.D- ��
Corttractors registration Numb er �Ij`\o,ea999a42,_, Expiration date "fa -'/O`}
Right of Wny:
Pavement or stdewalk intrusive. Yes _ No
Nullitve outside of pavement or sidewalks. Yes No
Length oleo_ _ __ ft. Depth of cut ft. Width of cut ft.
Direction of cut
Contact person W-1‘1
Adtiress of contactwj1- vkS- rley Phone
Plan se explain In detail the description of the activity proposed. .7\C •1/4ler..,_
1 hsreby authorize the City of Spokane Valley to charge this permit fee to my charge card.
Vita mastercharge _,_ REDACTED REDACTED
--.M,` x.si� .:.tt.a-�--(—�y.,,��,,�� y1
PrintnameotholderQ lYiS_ V\A\ Signature c_iii\I A,. hll.� _ E
P1;flMIT:
Restoration: , Permanent_ Temporary
Typo of back fill to be used: . eravel•, Crushed _ CAP
V —' REDACTED
IS 4 COPY OFA BOND DZPOSITED WITH TOE CITY OF SPOKANE VALLEY 7
A COPY OF 1'IIE CITY / UTILITY LIABILITY INSURANCE POLICY MUST BE ON
Yif,l AT Tlft?, CITY.
PF;1t1‘i IT i+},T; S INSPECTION FEE S
AHirt; vcd
3— 3 -os—
Publio Works Director Date
CALI,.24 HOURS .BEFORE INSPECTION NEEDED
Phone 509-688.0036 Fax. 509-688-0037
R-0•wArr,
MAR 03 2005 13:42
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