2005, 09-21 Permit App: 05003476 ROWSpokan
too/Valley
Call 24 hours before inspection required
Phone 509_688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date _09-23-2005_Permit # Account #
ROW CONSTRUCTION PERMIT
LOCATION OF PROPERTY- 1626 s Pines rd
(Address/Parcel #, if available)
Applicant Name Avista Utilities Fax 534-2463
Address 1411 E. Mission Ave. Spokane, Wa. 99202 — Katy msc46 Phone 509-495-4152
Customer's Name Avista
Address Phone
Contractor's Reg.# Expires
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
Sewer Connection Driveway
Curb & Gutter
Cable/Conduit/Pole
Water Installation/Repair
Pavement Cut
X
Gas Installation/Repair
Sidewalk Repair/Construction
Other
Dimensions
Bond/insurance certification must be on file with the City. Bond #
SPECIAL INSTRUCTIONS): Install a 45ft gas service off main located 15ft west cl of Pines 0
asphalt job #88 31 7225 7
1
Permittee Signature_KCC
Approved
Date
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card # Expiration Date
Name of Holder Signature
Fees Paid$
25.00
Date
Init
(Application) (Inspection)
In addition to the permit application fee of $16.00 (utility) or $25.00 (construction), inspection on
each permit will be billed to the permittee at a rate of $50.00 per hour with a $25.00 (1/2 hour)
minimum. Permittee signature constitutes an agreement to these terms and provisions.
Work completed satisfactorily (Signed)
Date
Permit not valid until One -Call Notification Ticket # entered here
PERMIT MUST BE KEPT ON SITE