2005, 07-06 Permit App: 05002317 Plumbing Reversal, ROWJUL-06-05 WED 10:05 HV
APR 00 2083 14110 FR TO 9283474
P.01/02
City of "15tRN1rT # PW
SPOYCA . + VALLEY
UTILITY RICHT — OF — WAY APPLICATION AND PERMIT
runic WORKS DEPARTMENT Date project starts 1 --- :S
Date Project ends 1 - 1
C s- ? ' 1
APPLICATION
Location of property involved (or address) \ C \ n
Hance of company
Porr‘ine
15
vtc
1Qn
Address of company b4 j�. -1:-$C\-\\`'At1 'z \ ° - bphone
Contractors name
Contractors addxcssj,Q,
Contractors registration Number_\tlSAtk,CQ 999 k
'tight of Way:
Povetneut or sidewalk Intrusive, Yes No
intrusive outside of pavement or sidewalks. Yes No
Length of cut ft. Depth of cut ft. Width of cut ft.
Direction of cut
ContAet person
Address of contact_ :'jt}- 3 n- ;r�e Phone --1-D-y3
Please explain hi detail tho description of the activity proposed,
gD,e may 3
phone q210 -.���
Expiration date -1/g-.31 09
+iY
1 htrtby Authorize the City of Spoksertecy to charge this permit fee to my charge card.
Visa (1)a.sterehtr` _ - - �eo it ,. _ .,
Print ns me of holderCUY111t�, �` Signature
PEWIT:
I /u
This document originallycontained
Restoration: confidential credit card information which
3'ermanent ' Temporary was redacted pursuant to RCW 19.255.010
Type of beck fill to be used: • travel • Crushed CDF and the original document destroyed
75171Stlant to SOS DAN GS2014-030.
IS A. COPY OF A vOND DEPOSITED WITS TEZ CITY OF SPOKANE VALLEY T
A. COPY OF TECO CITY / UTILITY LIABILITY INSURANCE POLICY MUST B$ ON
.?JLY AT TLXE CITY.
PERM' PEES INSPECTION I'LL $
App'rbved
Oar.
Public Works Director Date
CALL 24 HO URS BEFORE INSPECTION NEEDED
Phone 509-688-0036 ' Fax . 509.688-0037
? - D •warp,
JUL 06 2005 10:03
PAGE.02