2006, 02-02 Permit: 06000310 ROW -.r?r
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Call 24 hours before inspection required R �r
Phone 509.688-0036 Fax 309.688-0037lio
SökaneCITY \%itr
,;,.Walley -
DEPARTMENT OF PUBLIC WORKS _ ', ., ;4.,
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Anticipated start date Permit# PW
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ROW CONSTRUCTION PERMIT
Location of property \--\'''' \V , , �ia p, � + ,
\ \ (Address/Parcel#, If available) 1 ,lr;1 ,., t,..-1.
Applicant Name `-lo�.o.t.,�c....a� �A,,� r � ', �r „
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C` T..S l u� 1
Address
`��,1 �cc( �S. Phone �S�`3.- �4o`t y`.' '�i',..,-,,,;..
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Contractor's Name ''' ;:e
Address i-41,1.,:-
Phone
Contractor's Reg# ��� . 'S c-S.CYNok Expires i ,;r! r,.
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for ` '` `^
ssary clarity) t r
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Sewer Connection Y Driveway ,, 1;=i
Curb &Gutter Gas Installation '
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Cable/Conduit Sidewalk Repair/Construction ' . ,tr
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Other J. T'G 1 ,K.ay;
Pavement Cut? Dimensions '� r " �
Bond/insurance certification must be on file with the City. Bond# '3'..-4,:",; 4. 4 t
SPECIAL CONDITIONS: e:-'1,7':: :r ,,
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Permittee Signature J Approved '�
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card x_
Card# ,� � + � .�° 1.,,Expiration Date r .a*
Name of Holder ,.--- `r. s -,
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SI•nature y
Fees Paid$ Date 1114 : s
(Application) (Inspection) �' L,
In addition to the permit application fee of$16.00 or$25.00.Inspection,
on each permit will be.i <
billed to the permittee at a rate of$50.00 per hour with a$25.00(1/2 ,,
hour)minimum.Permittee � � 4)--,
rsignature on permit constitutes an agreement to these terns and provisions. ,
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Work completed satisfactorily(Signed) Date � ��Yr `
Permit not valid until One-Call Notification Ticket#entered herer.,t
PERMIT MUST BE KEPT ON SITE