2003, 03-31 Permit: PW03-003 ROW City of PERMIT # PW 03 -oo
SPOKANE VALLEY
UTILITY RIGHT— OF — WAY APPLICATION
AND PERMIT
PUBLIC WORKS DEPARTMENT
APPLICATION r /
Location of property involved (or address) ) , 1 6 $ �A/Z,. (.,lazc-E_
Name of company Q,'dcl;f 5 r5 i4 4. t
Address of company //b(Z /l. E(-T., I o�a phone 7 2 2 -5Cf :27
Contractors name IRo -- Cj .,-.i c s it .5
Contractors address S‘,61. U phone -�'i'i€
Contractors registration Number A\ J- ( - ?8 'C X Expiration date
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 o ut
Contact person ¢e,- 0;4 cj j
Address of contact .„.----;),1--) A Q Phone
P • : • explain in detail e • description of t •tactivity propos•d.
=tea •
— •i vt C �nLi
I hereby authorize the City of Snnkant.V.no.,to nharop the ffe�for this permit to my cruet card:
sa Mastercharg4 _ _ _ igit(, V
Print name of holder v Sten 6 cdc/j t Signature Ki= _OfY•
U
PERMIT: Special Conditions
Tl,;, ducumeni orlglltany contained
confidential credit card information which
55.010
and the original document destroyed
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 $ /Q.00 INSPECTION FEE $
Approved
( zeoC P 3 -3 I-�
Public Works or Date E C E 5 l [
CALL 24HOURSBEFORE INSPECTION D
NS CTIIN NEEDED
Phone 509-688-0036 Fax 509-688-0037 MAR 31 2003
R-O- WAPP. D
o UOLDQNI