2015, 01-26 Permit App: ROW-2015-0037 Repair Water Service LineV 1 LV 1 V 1 V V • VVI 1111
Spokane
Valley -
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@sookanevaliev.org
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
RIGHT OF WAY (ROW) PERMIT APPLICATION
❑ APPROACH
[2 PAVEMENT CUT (SEE BELOW) ❑ SIDEWALK
❑ CURB & GUTTER ❑ WORK THROUGH MANHOLE ❑ OTHER
ROAD OBSTRUCTION [ NO ❑ YES (if yes, complete the following)
• % of street or # lanes that will be obstructed:
• Length of time street will be obstructed:
b If work closes more than 50% of a local access street, or closes any portion of an arterial street,
then a TRAFFIC PLAN IS REQUIRED 0 Pre -Approved TCP Proposed:
PROJECT ADDRESS: 14/5011 E 611-1.40k.) PARCEL NUMBER:
APPLICANT'S JOB #: LOCATE TICKET # /50/ ! 74,
START DATE: 1 fZ°/ / I5 ANTICIPATED COMPLETION DATE: Z 5//5
PROJECT DESCRIPTION: Is_CP/4(R._ %AK.i k.)G, (,c)At .SE'.cQLC.& Li A.).
PROPERTY OR BUILDING OWNER INFORMATION (XF APPLICABLE)
NAME:
MAILING ADDRESS:
Cm:
STATE; ZIP:
PHONE:
FAX:
CELL:
CONTRACTOR INFORMATION
NAME: VERA WATER & POWER
MAILING ADDRESS: PO BOX 630
CITY: SPOKANE VALL
STATE: WA ZIP: 99037
PHONE: (509)924-3800
FAX: (509)922-3929
CELL:
CONTRACTOR LICENSE NO.:
EXPIRES: CITY BUSINESS LICENSE NO.:
BOND INSURANCE CERTIFICATE # (per SVMC Title 10, Article 2):
CONTACT NAME: TODD HARMON
PHONE: (509)924-3800
Modified April 14, 2014
C:\Users\tharmon.VERAWP\Documents\SRokane Valley ROWPA doc
Received Time Jan, 26. 2015 3:59PM No. 1445
Page 1 of 2
VI GV IVII
**** IF PAVEMENT CUT, COMPLETE THE FOLLOWING ****
NATURE OF WORK:
(circle one)
Gas
Electric
CATV
Communication
Sewer
Other
Water
TYPE OF CUT/REPAIR:
Scircle one)
Gravel
Concrete
Other
Asphalt
SIZE OF CUT
(width) x (length)
,11X "'
STAFF TO COMPLETE:
ROAD TIER: PAVEMENT CUT POLICY APPLIES?
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) If this permit Is for construction or on a dwelling, the dwelling Is/will
be served by potable water. 2) ownership of this City of Spokane Valley permit Inures to the property owner. 3) The signatory Is the property
owner or has permission to represent the property owner In this transaction. 4) All construction Is to be done in full compliance with the City or
Spokane Valley Development code. Referenced codes are available for review et the City of Spokane valley Permit Center. 5) The City of
Spokane valley permit Is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
Information may be required to be submitted and subsequently approved before thls application can be processed.
EXPIRATION
Right-of-way permits Issued between AprII 1't and September 30th are valid for 30 days after the date of Issuance, with a one-time 30 -day
extension avallable. Right-of-way permits Issued between October 1" and March 31't are valid until the following April 30th.
Applicant Signature: �7- :.. Date: //2-4
f
Method of payment: D Cash ❑ Check ❑ Visa** ❑ Mastercard**
** If paying with credit card, the City will call for credit card information when the permit is ready to be issued.
PLEASE FAX TO CITY OF SPOKANE VALLEY (509) 688-0037 UPON COMPLETION
Modified AprII 14, 2014 Page 2 of 2
C:\Users\tharmon.VERAWP\Docuntent51$Dokane Valley ROWPA.doc
Received Time Jan. 26. 2015 3:59PM No. 1445
* * * Communication Result Report ( Jan, 28. 2015 8:44AM ) * * *
Date/Time: Jan, 28. 2015 8:44AM
File
No. Mode
Destination
P 1
1) Spokane Val 1ey Permit Center
2)
Page
Pg(s) Result Not Sent
1451 Memory TX 99223929 P. 4 OK
Reason for error
E. 1) Hang up or 1 i ne fail
E. 3) No an swe r
E. 5) Exceeded max. E—mal 1 size
E. 2) Busy
E. 4) No f a c s im 1 e connect ion
City of Spokane Valley
Community Development
11703E. SpregUe Ave., Sake B3
Spokane Valley, WA 99206
(500) 7205240
permNcemertgsookerhevellev.gfq
ROW -2015-0037 DE -ROW
PROJECT NAME: I9SUED: 01/2012015
SITE ADDRESS: 14504E MALLON AVE SPOKANE VALLEY EXPIRES:
PROJECT DESCRPTION_ REPAIR LEAKING WATER SERVICE UNE
PARCEL: 45143.0741
APPLICANT. VERA WATER POWER -INVOICE OWNER: VERAWATERR POWER -INVOICE
60 ROX630 VERAOALE, WA0037 PO 60X 030
509/221525 VIRAOALE, WA99037
5098223029
OWNER ACTING AS BIRDER:
VERA WATER & POWER
PO BOX 63e
VERADALE, WA96037-0630
Llama OWNER
Expiate:
FEE& Paid 12Vg
Right of Way $210.00
Totals : 0219.00
CONDITIONS
• Prier to excavation, itis the Contractor responsibility be oontact the purveyor of any transmission pipeline that Is Within 100
feet of permitted week, as per RCW 19.122.033.
For work docking less than 50% of a local acoess street the contractor, ata minimum, le roquimd to have Construction
Ahead signs placed ahead of the work zone. Note — if it turns wither the work blacks more than 50% of a local assess
street then this permit Is not valid and the contractor must submit. a Serve control plan lo the City for revioMacceplanoe prior
to continuance of the work All Irattccentro! shall follow MUTCD standards.
• • For pavement els. as-hult drawings (using the current Inland Northwest Regional Pavement GW Pettey template) ora
required to be submitted to the Right -of -Way Impactor, Scot Wallace, within 15 working days of work being completed. As-
bullts shell be submitted by email (to swallate®spokenevalley.org), by Fax (509921-1008) or by dropping olt at the Panne
Center.
• - AO pavement cuts within the City of Spokane Valley r(ghtof--way shall onmpy with the currant adopted Inland Nort0est
Regional Pavement Cut Polley, oras amended.
• All pavement repairs shell be inspected by the 011ys ROW inspector, Scott Wallxe (mobile: 509.869-5373). The
Contractor shall notify Mr. Wallace a minimum o124 hours In advance of the paving.
PMle0 try: Patna rreW w or[ 00052015 0014* AN