2005, 05-23 Permit App: 05001750 ROW, Plumbing Fixturesr4Y-23-05 MON 12:25 PM A
• nm (+0 200.3 1.1110 FR
City of
SPOKANE VALLEY
Ufa XIV MON i r -• OP — WAY APPLICATION AND PERMIT
FU. 'LIC WORKS DEPARTMENT Date project starts
Date Project ends
TO 9283474
P812MIT # PW0
S "T2 .)S—
APPLICATION
Location of property involved (or address) h. 19) VVCfine. (2,cL
Name of company
Address of company-) N. `-1754 NY et' -1
Contractors natne
phone qD,t(t 3
Contractors address rRr _
phone 012b
Contractors registration Number V \\.Q\
Right of Way:
Pavement or sidewalk intrusive.
Expiration date -1(a3I Oki
Yes No
ITiti-usive outside of pavement or sidewalks. Yes No
Length of cut ft. Depth of cut ft. Width of cut
»lydctton of cut
Contact person,
Address of contact
ft.
Phone g -1 3
Please explain lu detail the description of the activity proposed..
I hereby ttutborlze the City of Spoksn6"...._t�'_ -
RE�A��
Visa ;Ile;tercbtrgc _
Past nines of holder SP:m_ ic k\ r Signature
rmitit
•
'1 1 , .
V '' t ,�
This document ongma;ly contained
confidential credit card information which
Restoration: • Permanent_ 'Temporary was redacted pursuant to RCW 19.255.010
Typo of beds 1111 to be used; • travel • Crushed cDF and the original document destroyed
is © OF A BOND DEPOSITED WITH TRE CITY OF SPOKANE VALLEY ?
A. COPY Air TIM CITY / UTILITY LIAIIILITY INSURANCE POLICY MUST BE ON
•ik.rrrig QTY.
prilusur V'EE S INSPECTION PEE $
• A,1►prOved
porsUant to SOS DAN GS2014-030.
•
Potato Works Director
S --o��
Date
CALL 3d HOURS' B,BFORBINSPECTION NEEDED
Phone 305.688-0036 ' ' Fax . 505-688-0037
MAY 23 2005 12:24
PAGE.01