2004, 03-18 Permit App: 04000134 Driveway*lane
Valley
Call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date Permit # 04-134 Account #
ROW CONSTRUCTION PERMIT
Location of property 211 N. Marguerite Rd.
(Address/Parcel #, if available)
Applicant Name Jess Jameson Fax
Address 310 S. Pines Rd. Spokane Valley, Wa. 99206 Phone 509-953-7383
Contractor's Name
Address
Phone
Contractor's Reg.# Expires
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
Sewer Connection ■ Driveway
Curb & Gutter n Gas Installation/Repair
Cable/Conduit/Pole
Water Installation/Repair
Pavement Cut
nSidewalk Repair/Construction
n Other
Dimensions
Bond/insurance certification must be on file with the City. Bond #
SPECIAL CONDITIONS: Construct driveway approach per Spokane County Standards as
adopted by the City of Spokane Valley.
Note: Approach must be a minimum of 16' wide and a minimum of 7-1/2' from property line.
See attached Provisions
Permittee Signature Approved —�_ `� Date .3 /
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
25.00
Date
Init
(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)
Permit not valid until One -Call Notification Ticket # entered here
Date
PERMIT MUST BE KEPT ON SITE