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2015, 06-10 Permit App: ROW-2015-0339 ROW ,u s.....1‘./11,41‘...,.., I... . . '= to ___ 1 ..' IIJEuf g. -Spr ,c_'ve,Suite E ::;00 Valley' Spcltane ifai ey.WA 99206 .TO T=Z - _ � ley' (=O9)663-003 FAX:(609)688-0437 .-,,,nwspokannt va11e•r.or; Con'Armiyi yDrve1Gr1 e i ROW Construction Li Driveway ❑ Pavement Cut ***0 below) Permit Application ❑ SidewalkL! Curb ea Gutter DK Other 3 �� lV, c '2 4 J� �� Road Obstruction [ No Ci Yes (traffic carzol plan require4) ten,. .451 START DATE �-y ANTICIPATED CON2LETIOA DATE 1" T7" , /,'a '�IZic!. L: :�{% : ...:. 4ntr�vioF'� Naar: 717/L/,' - e__ i/'✓--, �� Name: 4.dt s5: . LO ( CK g.c E 4 u Address:� City:S ma, G 4-rf E State: A14- zip: :?/ CiiY: - 3wtt: Zia: Plane: �� 9a-2(;' S�3Fax: e'er -8 P 7 • : Phone: P.5.-x: Cc�aisci:tiei /k' ' '.:cXp -:: AF.C-'• • _ _ - Co:►�acto.:,ic No: �.�,"p Date: H City B i ess Lic.No: ®w u Tom:: 9 5V - 3 3 _12Z....-G:. s// Tier Policy. _... **MUST BE COMPLETE IF PAVEMENT CUT** � k Type O pC iC ndHon of CAIC7u Savecu: / / _.,A n LT 7 / v9 / Elec ±d( rz-approved only) Of Fate-, ` 0-�LOtao /C0,410 `O/LL Gc,T G/7_4 8. L CATV Cot=runiceduns //V 2 L4 C E_ • Other :Tv p,aY R.er x.uistisa Road Coudifiors Asphalt Depth of Asphalt Coact to Depth of Gravel S- /L6s 1./d Asphalt Concrete Locate Ticker# Widz!1 Leasth Widti: i eaglis x x BO/ N NC CERT /0 3S3 3 ? (PER S` rvIC TITLE 10 .ARTICLE 2) Signature C'-,r /`r/�,e 4s,ll44• Cam 67/6 /3 '7"'"----- Method (� 4 of Payment Lam° Cats Check 0 Mastercard 0 VISA Ban:Lcatd nC Expires: '1 #: !tUtarirol 5/gnawrra: - WCik completed utistectorily lute (INSPECTOR) PLEASE FAX TO CITY OF SPOKA.NE VALLEY UPON COMPLETION {50908 GG3T Row-0/6'-0;;9 Received Time Jun. 10. 2015 8: 18AM No. 1993 -- —