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2013, 08-18 Permit App: ROW-2013-0409 Sewer Connect
Spokane ,r,,. Va11ey Community Development Department Permit Center 11703 East Sprague Avenue, Suite B-3 Spokane Valley, WA 99206 Tel: (509) 688-0036 Fax: (509) 688-0037 permitcenter sookanevallev.orq (Staff UseOnly) PERMIT NUMBER: (Q )y 1. --40q PERMIT FEE: RIGHT OF WAY ROW) PERMIT APPLICATION d DRIVEWAY EJ PAVEMENT CUT (SEE BELOW) 0 CURB & GUTTER OTHER ROAD OBSTRUCTION PROJECT ADDRESS: /5 ^20 START IM -71T:-20 —/ ? 0 SIDEWALK 0 YES ***TRAFFIC PLAN REQUIRED Q4-5. /15 .S, 4.144-e trC/4 ANTICIPATED COMPLETIO�y%Ny,�"'JDATE�.^�/�lJ t� 1 BUILDING OWNER NAME: NAME: ADDRESS: CITY: PHONE: CONTACT NAME: PHONE: STATE: FAX: ZIP: C:..,\r/c LLE:' ir CENTER SUB # ! ' 1-1 ..H V, FAX: CELL: CONTRACTOR NAME: ( /itor- Cori N ��i�-OgiU,p j:.9,-7 MAILING ADDRESS: z7?. CITY: �� ^7STATEE:�lN4 ZIP: ' PYO PHONE: � _2Z6—// 2) FAX: 5-D -726 2 %- 6 CELL:eV 99--91 -2f,w CONTRACTOR LICENSE N 0, : VegZ, ti9VZjEXPIRES:(; --2k-/1"/ CITY BUSINESS LICENSE NO.: 062 ?,;D TIER: POLICY: BOND/INSURANCE CERTIFICATE #: (PER SVMC TITLF10tRTICLF?) SIGNATURE: DATE: ,—/2 -/� ****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 CATV Comm. Sewer Other Effective October 28, 2007 Page 1 of 2 http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Right of Way_(ROW)_Permit_App_1-.11-11.doc