2015, 05-04 Permit App: ROW-2015-0231 Remove, Replace AsphaltRIGHT
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenterPsookanevallev.orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT PEE:
F WAY (ROW) PERMIT APPLICATION
1
❑ APPROACH '0', PAVEMENT CUT (SEE BELOW).
E. CURB & GUTTER ❑ WORK THROUGH MANHOLE
SIDEWALK
OTHER
ROAD OBSTRUCTION
b If work closes more than
then a TRAFFIC PLAN IS REQUIRED
PROJECT ADDRESS: 3764-
Ej NO ! YES (if yes, complete the following)
# lanes that will be obstructed: 3 O
• % of street or
time street will be obstructed:3_
• Length of
50% of a local access street, or closes any portion of an arterial street,
TCP Proposed:
Pre-Approved
:
S .SLA Ot c)V1 DOARCEL NUMBER:
47OK LOCATE TICKET
JOB #: Q
APPLICANT'S .34
START DATE: 5 /Vl /1-,.; ANTICIPATED COMPLETIO DATE: Sj�
/S
PROJECT DESCRItTION:
i
RG1r7002-74- 4 &C -e... j.‘pil Olt366
PROPERTY OR BUILDING OWNER INFORMATION (IF APPLICABLE)
NAME:
CITU: STATE: ZIP:
MAILING ADDRESS:
FAX: CELL:
PHONE:
CONTRACTOR INFORMAT
NAME:-L-`%/Ce/e7e. ,
ON
IP,' 6-, .
wA.
�% j
37-y::::(,„ CITY: i'- -"�- STATE: t ZIP: g -(Z(
MAILING ADDRESS: ��' 44.)(
-PHONEM IC/ I 1 10 I '`i 650 -c -5/1n. FAX: V-/ ^ 536p-3051.0
NO.: EXPIRES: CITY BUSINESS LICENSE NO.:
CONTRACTOR LICENSE
BOND/INSURANCE CERTIFICATE #
(per SVMC Title 10, Article 2):
/
l_�- OcDk— (� -`7PHONE: -(77 - 63/
CONTACT NAME:
-ra)C_ )2044
arc te
R75o L-ZaIS' -ci �l
11 Forms B Develo s ment En ineerin ROW PA doc
Page 1of2
TYPE III TYPE III
BARRICADE BARRICADE
LEGEND
K TEMPORARY SIGN LOCATION
TYPICAL ROAD CLOSURE - LOCAL ACCESS
NOT TO SCALE
SV -TC -102
7?Ol✓-7 i'5' -o7 /
J••
NOTES:
1. NO FLAGGER'S OR SPOTTERS.
2. ALL SIGNS ARE BLACK ON ORANGE.