2006, 10-26 Permit App: 06004302 ROW, CableFROM
(THU)00T 20 2000 12:30,ST. 12:30/Ho. 7300000331 P 1
S°po°a�lle
Call 24 hours before inspection required
Phone 509.688-0036 Fax 509.688-0037
y DEPARTMENT
OF PUBLIC WORKS
Anticipated
Location
Applicant
Address
Contractor's
Address
Contractor's
start
of property
Name
date Permit # PW
ROW CONSTRUCTION PERMIT
/ 2 3/ 6 E wu4c.v ct
(Address/Parcel #, if available)
&C1CSt- carp
9i Dy
At CaLirt6USI saktit.Phone sb9-5i $ - 2-91g
Name
Phone
Reg#
Expires
PROJECT DESCRIPTION
(Provide site
sketch
with the
or
plan as necessary for clarity)
Driveway
Gas Installation
Sidewalk Repair/Construction
•
Bond/insurance
Sewer Connection
Curb & Gutter
Cable/Conduit
Other
Pavement
certification
Cut? . Dimensions
must be on file
City. Bond 4 —
SPECIAL CONDITIONS:
Permittee Signature
/cc'� Approved
I hereby
Card
Name
authorize the
4
Crty of Spokane Valley to charge the fee for this permit to my credit card.
Expiration Date
of Holder
Signature
Fees Paid$
Date
!nit
(Application) (Inspection)
In addition to the permit application fee of $16.00 (utility) or $25.00 (construction), inspection on
each permit will be billed to the permittee at a rate of $50.00 per hour with a $25.00 (1/2 hour)
minimum. Permittee signature constitutes an agreement to these terms and provisions.
Work completed satisfactorily (Signed) Date
Permit not valid udtit One -Call Notification Ticket fi entered here
PERMIT MUST BE KEPT ON SITE
OCT 26 2006 13:07
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OCT 26 2006 13:07