2015, 05-19 Permit App: ROW-2015-0272 ROW , a
Community Development Department
0#11\111Permit Center (Staff Use Only)
11703 East Sprague Avenue,Suite B-3
1 �^ Spokane Valley, WA 99206 PERMIT NUMBER:
c Tel: (509)688-0036
4,000Vall.e3r Fax: (509) 688-0037 PERMIT FEE:
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RIGHT OF WAY ROW PERMIT APPLICATION
APPROACH PAVEMENT CUT (SEE BELOW) SIDEWALK
CURB &GUTTER WORK THROUGH MANHOLE 0 OTHER
ROAD OBSTRUCTION 0 NO 0 YES (if yes, complete the following)
• % of street or # lanes that will be obstructed: Less than
50% of non arterial
• Length of time street will be obstructed: 2 hrs
b If work closes more than 50% of a local access street, or closes any portion of an arterial street,
then a TRAFFIC PLAN IS REQUIRED 0 Pre-Approved TCP Proposed:
PROJECT ADDRESS: 7857 E RATTER AVENUE PARCEL NUMBER:
APPLICANT'S JOB #: LOCATE TICKET#
START DATE:5/21/15 ANTICIPATED COMPLETION DATE: 6/30/16
PROJECT DESCRIPTION: COLLECTION OF WASTE WATER SAMPLES FROM SEWER MANHOLE(BI-MONTHLY)FOR
LABORATORY ANALYSIS. SEWER MANHOLE IS IN SHOULDER OF E.RUTTER AVENUE,WHERENECTAR[TINTERSECTS:
ti
ry . .
a - 4 ;-
PROPERTY OR BUILDING OWNER INFORMATION (IF APPLICABLE ,;,
NAME: NA
MAILING ADDRESS: CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR INFORMATION
NAME: LANDAU ASSOCIATES
MAILING ADDRESS:10 N POST ST.STE 218 CITY: SPOKANE STATE:WA ZIP:99201
PHONE: 509-327-9737 FAX: 509-327-9691 cm: 509-995-1665
CONTRACTOR LICENSE NO.:
LANDAA1034MN EXPIRES: CITY BUSINESS LICENSE NO.:
600557469
BOND/INSURANCE CERTIFICATE#(per SVMC Title 10, Article 2):
CONTACT NAME: RYAN REICH PHONE: 509-995-1665
Modified April 14,2014 Page 1 of 2
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• , •
**** IF PAVEMENT CUT. COMPLETE THE FOLLOWING ****
NATURE OF WORK:
(circle one) Gas Electric Water CAN Communication Sewer Other
TYPE OF CUT/REPAIR: ~
(circle one) Asphalt Gravel Concrete Other
SIZE OF CUT
(width) x (length) None
STAFF TO COMPLETE:
ROAD TIER: PAVEMENT CUT POLICY APPLIES?
pISCLAIMER
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 30"' 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 1g and March 31"are valid until the following April 30`n.
Applicant Signature: -\�� —e.;e`—'� Date: 549-15
Method of payment: 0 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
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