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2014, 09-20 Permit App: ROw-2014-0495 Hydrant Repair09-16-14;02:43PM; Spokane Valley Community Development Department Permit Center 11703 East Sprague Avenue, Suite B-3 Spokane Valley, WA 99206 Tel; (509) 688-0036 Fax: (509) 688-0037 DermltcenterQspokanevallev.ora 1/ (Staff Use Only) PERMIT NUMBER: PERMIT FEE: RIGHT OF WAY ROW PERMIT APPLICATION CI APPROACH 0 PAVEMENT CUT (SEE BELOW) Q CURB & GUTTER 0 WORK THROUGH MANHOLE ROAD OBSTRUCTION • SXDEWALK Q OTHER NO EJ YES (if yes, complete the following) • % of street or # lanes that will be obstructed: • -Length of time street will be obstructed: i If work closes more than 50% of a local access street, or closes any portion of an arterial street, then a TRAFFIC PLAN XS REQUIRED 0 Pre -Approved TCP Proposed: PROJECT ADDRESS: 505 /L Peoc s gl PARCEL NUMBER: APPLICANT'S JOB #: LOCATE TXCKET # START DATE: G/G;(/!a ANTICIPATED COMPLETION DATE: p PROJECT DESCRI TIO RECEIVED PROPERTY OR BUILDING OWNER XNFORMATION (IF APPLICABLEk NAME 7714 CENTER MAILING ADDRESS; CITY: PHONE: FAX: CELL: CONTRACTOR INFORMATION NAME: VERA WATER & POWER MAILING ADDRESS: PO Box 630 crrv: SPOKANE VALL STATE: WA zip: 99037 PHONE! (509)924-3800 FAX: (509)9224929 CELL: CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.: BOND/INSURANCE CERTIFICATE # (per SVMC Title 10, Article 2): CONTACT NAME: TODD HARMON PHONE; (509)924-3800 Modified April 14, 201.4 Page 1 of 2 C:\Users\tharmon.VERAWP\Documents\Sooka a Valley ROWPA.doc Received Time Sep, 16, 2014 2:28PM No.0951 09-16-14;02:43PM; **** IF PAVEMENT C!JT, C©MPLETE THE FOLLOWING **** # 2/ 2 NATURE OF WORK: (circle one) Gas Electric Water CATV Communication Sewer Other TYPE OF CUT/REPAIR: /circle one) Asphalt Gravel Concrete Other SIZE OF CUT (width) x (length) STAFF TO COMPLETE: ROAD TIER: PAVEMENT CUT POLICY APPLIES? DISCLAIMER The permitted verifies, acknowledges and agrees by their signature that: 1) If this permit Is for construction or on a dwelling, the dwelling Is/will be served by potable water. 2) Ownership of this City of Spokane Valley permit Inures to the property owner. 3) The signatory Is the property owner or has permission to represent the property owner In this transaction. 4) AU construction Is to be done In full compliance with the City of Spokane Valley Development code. Referenced codes are available for review at the City of Spokane Wiley Permit Center. 5) The City of Spokane Valley permit Is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional Information may be required to be submitted and subsequently approved before this application can be processed. EXPIRATION Right-of-way permits Issued between April Pt and September 30th are valid for 30 days after the date of Issuance, with a one-time 30 -day extension available. Right-of-way permits Issued between October 1St and March 31.1' are valid until the following April 30th. Applicant Signature: -Date: Method of payment: ❑ Cash 0 Check ❑ Visa** 0 Mastercard** ** If paying with credit card, the City will call for credit card Information when the permit Is ready to be issued. PLEASE FAX TO CITY OF SPOKANE VALLEY (509) 688-0037 UPON COMPLETION Modified April 14, 2014 Page 2 of 2 C:\Users\tharmon.V_FftAWP\DOCuments\Sookane Valley ROWPA.doc Received Time Sep. 16. 2014 2:28PM No, 0951