2005, 12-21 Permit App: 05004700 ROWne
Milley
Call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date 12/16/05 Permit # Account #
ROW CONSTRUCTION PERMIT
LOCATION OF PROPERTY- S 1120 Robie
(Address/Parcel #, if available)
Applicant Name Avista Utilities Fax 534-2463
Address 1411 E. Mission Ave. Spokane, Wa. 99202 — Ann msc46 Phone 509-495-2244
Customer's Name Chris Duncan
Address Phone
Contractor's Reg.# Expires
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
7 Sewer Connection n D• riveway
El Curb & Gutter n G• as Installation/Repair
El Cable/Conduit/Pole n Sidewalk Repair/Construction
Water Installation/Repair I I O• ther
X
Pavement Cut
Dimensions 3x4
Bond/insurance certification must be on file with the City. Bond #
SPECIAL INSTRUCTIONS): Install 40 ft of gas main and 45 ft of gas service to new home I
Job # 295163289 Loc# 3413486
Permittee Signature_AKC 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)
Permit not valid until One -Call Notification Ticket # entered here
Date
PERMIT MUST BE KEPT ON SITE