2003, 07-17 Permit: BD-03-050 ROWl
City of PERMIT # P W -
SPOKANE VALLEY
UTILITY RIGHT — OF — WAY APPLICATION AND PERMIT
PUBLIC WORKS DEPARTMENT Date project starts
Date Project ends
(Please call for final inspection)
APPLICATION
Location of property involved (or address) ?st2o
Name of company C—c'r' c�� ,tip
Address of company i??/? E SkA(5 �✓
Stamm -e
Contractors name
Contractors address
phone
SbS-g7ys-yii.S'
phone
Contractors registration Number Co cjCcc 4' gat e 7 Expiration date
Right of Way:
Pavement or sidewalk intrusive. Yes x 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
Kr .0 A
Address of contact ? S,R O E No 4 Phone
Please explain in detail the description of the activity proposed.
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 $ fro c cd INSPECTION FEE $
Approved
Public
�
Works Director
R -O- WAPP.
7// 7/45
Date
CALL 24 HOURS BEFORE INSPECTION NEEDED
Phone 509-688-0036 Fax 509-688-0037
1
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