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2006, 08-01 Permit: 06002763 ROW ii• .. Call 24 hours before inspection required Phone 509.688-0036 Fax 509.688-0037 /N .. . , ary my 011\ .. .. . . •,-,•-•-• :7, pok„.ane .. Valley DEPARTMENT OF PUBLIC WORK ,- - . .': -. .• ',..'.4';,''1••••c S '..' ' '. .- ,%-ii::' ';''''''• . • Anticipated start date `C.-\ - v- Permit# PW •,, .,ist..•.: - -i. -:•.. 2-,:l.: ,.., , •. -. , . •' r,•,. ' iliF144*-"" ROW CONSTRUCTION PERMIT • - —:: :;,:`,"-..;:i, •`.1' T,‘:1 Location of property \C\cat-\_\ c•....-.• ‘' ,..\, v,, \—c-i-,,... ' ' .. ..,.:.:• -.- • 1' .7•t,t- 1...*:', - • (A,d.dress/P(a.,r..cel.#, If available) ;Applicant Name ';'-'*..•.t.•I;.•1.4-,4,- -- --4 .,-,...4';:-.4.',..,-,::„f.....:,. f..,.vi :,:-.:•:\i:- Address S .--- \ .. c•-._ ,- ")•-•..c..: Phone St‘'')\" ..- at''..--- 1' ,-7'.....;,.!,•.,-,'",•-....T4,4, .7 4,4!'•-•r J!.s.•••' :. '`;-..',",` •, '...".„'A.,..1 ,-,..'•it''.7 ;;!•'',,,,-.64: ,•,;',' .:,• '".f,!%,`,..:'LA.'. .44,4,'i•I:if. Aff',,. ' - I' ' ' ;•,,wi-,41-,',?.!,,:,;.!•-; 'r,,,,..-.':;-10.,',,,:•` Contractor's Name •- • r•-•,..,. _1;,, .7, - Address Phone .'"e • ..., Contractor's Reg# . Expires , • ,: -raaf:' ,,-',.. . .-• •-•'?•‘ • '.- ..1-•r , *Ol' . t.• ':',1i PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity) ••• • -- .,„‘-'-- --c...1 ..' • \-. ,.. Sewer Connection FYIDriveway Curb & Gutter Gas Installation '.• -.' , '•',4 •'7.- •.;:. r) , - ••••<,• .k. - •Z••': ;:' , ,, •.,. • • •y- Cable/Conduit Sidewalk Repair/Construction ' 1, /':Y.,7,-r• `l.vii • ...:, , ,..3::-..7..;:,....: -,i.- Other ' • .1-!:',...iti:.;•.'4‘,.,..'1'..;', ;.• ___, .‘,..;.1,,,,., -,. ,_, , .;,.?.4.*, .....„.7,-.5.,::f.,A, ,.f,:--- •- Pavement Cut? Dimensions . . 7-4'...i,.) 1(;,°1,42"2, ;, ••• :4,..f-',1-. • r '. -.....,t: s . . --r , '. -A ' --•.!-''-,-. -,'.:.,,,,;..•,,,A--..;• .,. •'';. ;' • Bond/Insurance certification must be on file with the City. Bond# .' -- •.' '.v•-,:k,;•.'•' ,.. • .; .., ,.,:-'.-:• ,r,'•'" SPECIAL CONDITIONS: , •.. , . . :''z.:- :,;-!-'',„, ' ' ' "4-- V. - . .,.\....z..i. •44.. , ..... _ t's,,. ,:li•e,e,_ .417.s '`. , '''.:''-' s' 'CL:r: .-• 4 ,. , . .. . ., , ,,f,.1 „: ..,..•, ,p."..,,ii :?:0Tro,'•,_ Permittee Signature Approved -;:., .„.. ,...,,',.1.,•4... ''•-•• . . - ; -:'..'''‘,..... '-.A...,•), I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card. •;• •• .-,--,•• • ,..- -,,,,lap,.,.,t, Card# Expiration Date .'E' :Z •'-' .:44. "'-. . , • ..,• , •-•-,,,-A 4 Name of Holder Signature ' ,s . ,1•••., . . , , ,• Fees Paid$ Date kilt :, : • : ..,;.A.•• - -4". , ., • ..,•;-.....,,• ,r..„. (Application) (Inspection) ,_. 0 - • :-....:::t... ,' -. 13,., •i.•.:5.'.. In addition to the permit application fee of$16.00 or$25.00,inspection on ssch permit will be 1 ..', ; '.:,:"0 i ,'. i.' billed to the permittee at a rate of$50.00 per hour with a$25.00(1/2 hour)minimum.Permittee '.ci 'i. -''.1;`i.::14.•. •.'''.-/:,',;17,,;:„,,: . '" ., . .. -. .., • •;.:'.::: ,',.1.'• ,',.. signature on permit constitutes an agreement to these terms and provlskuls. •.,.: 4.,,?:!..,..-:.,,,,,,,.,x,,•,.....1„.•,,,,;,,,,,;.1 ,:,, . • - --1:f,''' .!.'3J,.•': Work completed satisfactorily(Signed) Date - -- ..,:4 '•-•:,', '.;-..•4-', ,•,... . :,- .. T''1, r. ';',•..,,,,, ,..:, ''' -• ' ': .v, .7'''•••' • Permit not valid until One-Call Notification Ticket#entered here • we- ,-,. 144-•',.',.. - PERMIT MUST BE KEPT ON SITE