2005, 09-30 Permit App: 05003596 Road Obstructionb `jI La/ Lbb'J b /..jl del j 1:)3 j 7 u GLC." 1 Rll+ I --- —
MAR 25 2003 1307 FR TO ?559000 P.02i02
.City of PERMIT # PW
SPOKANE VALLEY
UTILITY RIGHT — OF — WAY APPLICATION
AND PERMIT
PUBLIC WORKS DEPARTMENT
APPLICATION
Location of property involved (or address) N 'F Z 1 3IO NA)SON 'ROA -b
Addms of compjLnyjQ%&jML_aM%LVAUAWA phone
contradon .m
Contraire address phone
Contractors registration Number Expiration date
Right of Way:
Pavement or sidewalk intrusive. Yes No
Intrusive outside of pavement or sidewallcs. Yes ✓ No �
Length of eat Z2' ft. Depth of cut _4� ft. WIdth of cut (,- - ft.
Direction of cat 1�- Ta w6 ST
Contaat person Z#V(b To �4v Soy
Address of contact
Phone
Please explain to desalt the description of the activity proposed. /NS {Age 1,& j2
W4 -T' P- A4 A �5S _ ,._.
X bcccby as ftea t the City of 6"k ne valley to ebarge the fee for tbb permit to M croNt card:
Via Ma arc-----
Priatname of hoUter mpAtu-c i
YL+ KM1 : Special Conditions
Pmtoratiou: l'trmsnmt Tceaporary
Ty
jpe of bsek fM to be Qaed_ gtavai epi CW
IS A COPY OF A BOND DEPOSITED WITH THE CITY OF SPOKANE VALLEY?
A COPY OF THE CITY / UTILITY LIABILLITY ZSURANCE POLICY N= BE ON
EILx AT THE CITY. _
PERMIT FEE S INSPE - ON FEE S -
.Approved
Public Worm Director Date
CAU 24 HOURS BEFORE RUPECTIONNFEDEA
Piton 509-"8-0036 Fir 909485-0037
a -o- WA, -F.
)1ok TOTAL PPGE.02
SEP 29 2005 08 52 5097559000 PAGE.01