HomeMy WebLinkAbout2014, 10-24 Permit App: ROW-2014-0605 Water Main Repair •
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10-24-14; 03: 39PM; # 1/ 2
Community Development Department
Permit Center gu (Staff Use Only)
11703 East Sprae Avenue, Suite B-3
ScgOlialle Spokane Valley, WA 99206 PERMIT NUMBER:
Tel; (509) 688-0036
Valley. Fax: (509) 688-0037 PERMIT FEE:
400000
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Project ,. �,' • 11 '/ /O '
RIGHT OF WAY (ROW PERMIT APPLICATIE C E I V E D
El APPROACH [2( PAVEMENT CUT (SEE BELOW) ❑ QJ�
0 CURB & GUTTER 0 WORK THROUGH MANHOLE ❑ OTHER
ROAD OBSTRUCTION 1::] NO EYES (if yes, complete the foll¢wing)C�� PERMIT CENTER
• % of street or # lanes that wilhtmol sLAA*
• Length of time street will be amtructie'_ a• %• z
________
q If work closes more than 50% of a local ac ss street, or closes any portion of an.,rterial street,
then a TRAFFIC PLAN IS REQUIRED [ Pre-Approved TCP Proposed: —V--P 3..
PROJECT ADDRESS: X31"7 5. ?eU[_a SS eIPARCEL NUMBER:
APPLICANT'S JOB#: LOCATE TICKET#
START DATE: /0 Ar/ ANTICIPATED COMPLETION DATE: /Ziff/
PROJECT DESCRIPT ON.
6,M c--e_CvG/+ 11 PAI ie_ 0 C.-.20V r MAta(4) .
PROPERTY OR BUILDING OWNER INFORMATION (IF APPLICABLE)
NAME:
MAILING ADDRESS: CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR INFORMATION
NAME:VERA WATER&POWER
MAILING ADDRESS: PO BOX 630 CITY:SPOKANE VALL STATE:WA Zip:99037
. PHONE: (509)924-3800 FAX: (509)922-3929 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, 2014 Page 1 of 2
C: U -r : .. .VERAWP Doc •n ..,ane Valle •• _ ...
Received Time Oct. 24. 2014 3: 22PM No. 1158
10-24-14;03: 39PM; # 2/ 2
**** IF PAVEMENT CUT, COMPLETE THE FOLLOWING ****
NATURE OF WORK: Gas Electric Water CATV Communication Sewer Other
(circle one)
TYPE OF CUT/REPAIR: Asphalt Gravel Concrete Other
(circle one)
SIZE OF CUT
(width) x (length) /C7/X
STAFF TO COMPLETE:
ROAD TIER: PAVEMENT CUT POLICY APPLIES?
DIsQLAXMER
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) All 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 Valley 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 1°` 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 10 and March 31"are valid until the following April 301h•
Applicant Sign• - - - - -- . — Date: /D V /
Method of payment: ❑ Cash 0 Check 0 Visa** ❑ 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\tharmod_VERA.WP\Documents\SDokane Valley ROWPA.dos
Received Time Oct, 24. 2014 3: 22PM No. 1158