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2006, 02-28 Permit: 06000680 ROW Call 24 hours before inspection required . I A' Phone 509.688-0036 Fax 509.688-0037 SoCITY m-1 11,1\11144 pkane . .. . ,. .,. . , ._ „. ,... , . ... . . . .., . . . . . .. ... . DEPARTMENT OF PUBLIC WORKS , • - . ,,..:', . .,, • ' - - . - .1-tri.i..'.•,..- - : . ..-„;......--.y. . Anticipated start date Permit# PW - - - • -• -,-4-,ire. '' 4 ROW CONSTRUCTION PERMIT '; Location of property \---\5N\‘ . .. c- , .. (Address/Parcel#, if available) ...,• -,c4,,,, ,•::=4,:t0,.., , . ,-;::-ti,r;,:• A'''._ Applicant Name `e%, ---.. . ._.,\,c ...,.. . c_. ,.........,, 'N. , , i''fr.-:', Address Phone r•': •';'•:;* =,.• ;-,•:::P;;;;;; 1,4X ,.;:' ... '7,;44:•;;I:.:.;.., '-'14.1...."•.-- , Contractor's Name Address Phone • ...1. .4-- - - Contractor's Reg# Expires ., . 41... ...'4.1,g,...•:,,i, ::;,,.. ,.'.'1 PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity) . ,„.,. — ,,..,e_v;.,,,-.• ,-..,„._. . . X-.1 Sewer Connection Driveway '. . . . .. ri Curb & Gutter Gas Installation '',,.-,‘ . - 1,,,,/„314d,.:::• Cable/Conduit Sidewalk Repair/Construction . - SS T5 Other ' •••,',...: ,', ,j,4:1:Yiti: 4 ,. -tf''sk„ ,,, .,',.... ,, ,,,,•. :- ),.-,•4, '• - - •••'. s . _ Pavement Cut? Dimensions .,••...'P . - .' •,',..ii:t,'.ir-s-tg-;i1:: „,.,: .:, Ir-i4.,*a;:k1.; -/;%, .'w-•-,-,' ' ''' '.., ...,..r.;,,,,,,,v; ...,:,i;...;-,- ,,, .,,,.. Bond/insurance certification must be on file with the City. Bond# ' • '"- :-..:.7.-e.,1%, -...,„., SPECIAL CONDITIONS: - — . , :,•t-I, .,-,:oftrk •.- , ,. . ., ‘...-,-e,.•,.„4.__,,,-..--)N ‘'..i0e".. ,4,•1.s."..;A:Vf ,;1,'":.: " " .`. ' ' ',''"•f:t...41`,:7:4 V01,1 ::::::.; '""--,. *744- '',4'.'";- ' ' . - ., ..„Ate,,,..,4,2fv -,• 0-0 4;-.1?,-,-1.i:.."4%.",S?&';''., ,,;„, - - ". 7.- ,:ig..,;-::,1;i,i4.°,,,:.:•F:-;.-.AT! ':i: Permittee Signature Approved :. .-;.' P ....t,...4.:., ... ....••; • .-..,: ,,..,:,,,s,_,.•,...-,- I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card. -, .,.„.„,--. ,,,,t,W Card# Expiration Date .: ;-: :.. Name of Holder Si.nature • • 7,, ,r; ,..0. ,. , - Fees Paid$ Date [nit .., - • ,,.;:,..';.:,..,c,,,,',.., (Application) (Inspection) . - • • ' . --..-. :,.;-::- • :.,03,',;', t:,' :?.'s'. ,,,,'. -...`... In add Won to the permit application fee of$16.00 or$25.00,inspection on each permit wiU be billed to the permittee at a rate of$60.00 per hour with a$25.00(1/2 hour)minimum Permittee • ' ....,,e,....v . ,,,, *,. .,,,„ - signature on permit constitutes an agreement to these terms and provisions. 4•e?-,- •;.', ,,,,,:',i,-,3,s---4 ,' ':,'•'.': .:0;t-r Work completed satisfactorily(Signed) Date • ' •...:<'.3c . - 4.! , Permit not valid until One-Call Notification Ticket#entered here S • 0,,,-c.:—..64-,.7 PERMIT MUST BE KEPT ON SITE ,.