2006, 02-08 Permit: 06000368 ROW Call 24 hours before inspection required „c �s
Phone 509.688-0036 Fax 509.688-0037 , �t,
Spokane
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,-"Valley , . . • ::-.-•,;_-,.• `i-----
DEPARTMENT OF PUBLIC WORKS
• Anticipated start dateN.7.--5--• --.3-4-ii, Permit# PW `
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ROW CONSTRUCTION PERMIT '
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Location of property , \-\ j\-\ , s C-, • ' • ::fix" •'
(Address/Parcel#, if available) ;a frP .
Applicant Name �CC�cr o .,�cd.c�� cc„.,� ` `7','.-.t.'t4r .I;`
Address S. S\Z << \�.6. Phone �L.`�"1-�1Q:c QC `""'`r , , sem'
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Contractor's Name ;44:r.,•;';';:.",•:., r
Address Phone " >
Contractor's Reg# \\�kk--NE..E-'5�� -\�c Expires $ t* _;.
PROJECT DESCRIPTION (Provide site sketch or plan as necessaryfor
clarity) r;
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Sewer Connection Driveway
Curb & Gutter Gas Installation ``,..,.. .-,
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Cable/Conduit Sidewalk Re air/Construction 1 '' .
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Other o''
. 4 ,.,'.:.mac _ :',;'...71.'g,• ;;.
Pavement Cut? Dimensions ;{ ', 'i.,�c?)• t
Bond/insurance certification must be on file with the City.Bond# �- `- _ t..-
SPECIAL CONDITIONS: `
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Permittee Signature\ Approved
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card
Card# �€" r `' 1 "
Expiration Date �.
Name of Holder Si.nature
Fees Paid$ Date Initr; k�
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(Application) (Inspection)
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In addition to the permit application fee of$16.00 or$25.00,Inspectionon each permit will be+
billed to the permittee at a rate of$50.00 per hour with a$25.00 112 '
( hour)minimum.Permittee :� �1:.:
signature on permit constitutes an agreement to these terms and t``
proVisbns. ' 1y {�•� � w.+r S
Work completed satisfactorily(Signed) Date s >
Permit not valid until One-Call Notification Ticket#entered here µ ,„i „o,`
PERMIT MUST BE KEPT ON SITE