2003, 05-14 Permit: PW03-200 ROWCity of PERMIT # PW a,3 ----‘POD
SPOKANE VALLEY
UTILITY RIGHT — OF — WAY APPLICATION AND PERMIT
PUBLIC WORKS DEPARTMENT Date project starts
Date Project ends
(Please call for final inspection)
APPLICATION / n
Location of property involved (or address) SS -0g, IN r N3,1„0 (d 5
Name of company •jr,j,
Address of company /Lc.; 20 F . Secr-c f4 ri a -1—
Contractors name
phone 9'22 -'2 97
Contractors address phone
Contractors registration Number 0,11 ff sc. I tY-(Pin Expiration date
Right of Way:
Pavement or sidewalk intrusive. Yes No _
Intrusive outside of pavement or sidewalks. Yes _ No _
Length of cut ft. Depth of cut ft. Width of cut ft.
Direction of cut
Contact person
Address of contact
Phone
Please explain in detail the description of the activity proposed. j,va
_��
I hereby authorize the City of Spokane Valley to charge this permit fee to my charge card.
Visa mastercharge Valid Date
Print name of holder Signature
PERMIT:
Restoration: Permanent
Type of back fill to be used:
Temporary
gravel Crushed CDF
IS A COPY OF A BOND DEPOSITED WITH THE CITY OF SPOKANE VALLEY ?
A COPY OF THE CITY / UTILITY LIABILITY INSURANCE POLICY MUST BE ON
FILE AT THE CITY.
PERMIT FEE $ 1a5:00
Approved
INSPECTION FEE $
Po.
ublic Wor$s Director Date
CALL 24 HOURS BEFORE INSPECTION NEEDED
Phone 509-688-0036 Fax 509-688-0037
R -O- WAPP.