2003, 06-24 Permit: BD-03-404 ROW Cit) of • PERMIT # P Wf-O�'-41z171
SPOKANE VALLEY
UTILITY RIGHT-OF-WAY APPLICATION
AND PERMIT
PUBLIC WORKS DEPARTMENT
APPLICATION
Location of property involved (or address) i) I ') , y R .L0 14
Name of company D (� c)u RCila1 Y1 a C on�-r
Address of company lig ) ? S p G phone 9aLl -Sq g s
Contractors name U a,i\ C® c
Contractors address I q 1% 6 _ s' t�Q . phone c .t
Contractors registration Number S O L C f l
� �. $ 1 Expiration date / 0-03
Right of Way:
Pavement 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
Contact person S e LIZ u .%nQ ()CLAM
V1-e rl`Q--
Address of contact 19 8! g 6. SpR)u€ Phone 92 5 4 'j
Please explain in detail the description of the activity proposed.
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
Visa Mastercharge
Print name of holder Signature
PERMIT: Special Conditions
Restoration: Permanent Temporary
Type of back fill to be used: gravel crushed CDF
IS A COPY OF A BOND DEPOSITED WITH THE CITY OF SPOKANE VALLEY ?
A COPY OF THE CITY/UTILITY LIABILITY INSURANCE POLICY MUST BE ON
FILE AT THE CITY.
PERMIT FEE $ f G .CD INSPECTION FEE $
Approved
1
cilo
Public Works Director Date
CALL 24 HOURS BEFORE INSPECTION NEEDED
Phone 509-688-0036 Fax 509-688-0037 fp, A Ii
R—O- WAPP. �__/