2005, 03-14 Permit App: 05000920 ROW, Sewer, Plumbing Reversal MAR-14-05 MON 10 :58 AM A 5099283474 P. 02
is
firR 41 260 14110'FR TO 92e 474
P.01/02
City of ��RMIT # PW0.„0
-
SPO N' + VA . Y
UTILITY RIQI'IT--OP--WAY APPLICATION AND PERMIT
PUBLIC WORKS DEPARTMENT Date project starts 3-\b 0
Date Project ends 3 -\$ - '0 S
APPLICATION
Location of property Involved(or address)___1\1214 't- . Ns \.Q\ck O.\J ,
Norm of company V rtn :iam % 6.
an
Adtlrest •of com "
P Y ��� N �S��Y�Q� �-� 'phone 3
Cotatractors narue
Cor tractors address \R. phone C/A.O.i3 - ..4?j
Contractors registration Number Expiration date p1(a31 01.}
itigllt of Ways
Pavement or sidewalk tnitrusive. 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
Address of contact, t• i a' • - Plume
Please explain Its detail the description of the activity proposed.
16crtby authorize the City of Spokane'VallAv to charge this permit fee to my charge card,
Visa innarchsr%, CeC _
Rani As n14 Of holder mn1}►e. This document originally contained
Sigriatttrsconfidential credit card information which
PRMIT! -- was redacted pursuant to RCW 19.255.010
and the original document destroyed
t,e.s torn tloa; Permanent Temporary� pursuant to SOS DAN G52014-030.
Type of lack fin to be used!• gavel - Crushed CDF
y.....M-
IS A COPY 00 A BOND DEPOSITED WITH THE CITY OF SPOKANE'VALLEY ?
A COPY OF TUE CITY/ LIABILITY INSURANCE POLICY M1JST BE ON
IfaX AT'I'1:IE ern',
PERMi'T+EE 5 INSPECTION P'EL s
• A wrovicl
3 1 �t 0c
Pub ie Works Director Date
CALL 24 HOURS BEFORE INSPECTION NEEDED
Phone 509-688-0086 Fax , 509-688-0037
•
PAGE.02
MAR 14 2005 09 56