2006, 01-12 Permit App: 06000084 ROWSikikane
jvalley
Call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date 01/13/86 Permit # Account #
ROW CONSTRUCTION PERMIT
LOCATION OF PROPERTY- 11721 E Mansfield
(Address/Parcel #, if available)
Applicant Name Avista Utilities Fax 534-2463
Address 1411 E. Mission Ave. Spokane, Wa. 99202 – Ann msc46 Phone 509-495-2244
Customer's Name Avista
Address
Phone
Contractor's Reg.# Expires
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
1-1 Sewer Connection ❑
Curb & Gutter
Cable/Conduit/Pole
n Water Installation/Repair
Pavement Cut
x
Driveway
Gas Installation/Repair
Sidewalk Repair/Construction
Other
Dimensions
Bond/insurance certification must be on file with the City. Bond #
SPECIAL INSTRUCTIONS): Install gas stubs to vacant lots from east property line of 11715
Mansfield to west property line of 11801
Job # 197277421
Permittee Signature_AKC Approved
Date
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card # Expiration Date
Name of Holder
Signature
Fees Paid$ 25.00
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 until One -Call Notification Ticket # entered here
PERMIT MUST BE KEPT ON SITE