2015, 06-17 Permit App: ROW-2015-0360 ROW Community Development Department
Permit Center
b 11703 East Sprague Avenue, Suite B-3 (Staff Use Only)
j(tie Spokane Valley, WA 99206 PERMIT NUMBER:
�Jll ►iLl11L pp Tel: (509)688-0036
400000°�ll1r � Fax: (509) 688-0037 PERMIT FEE:
Dermitcenter{n�sookanevalley,org
RIGHT OF WAY (ROW) PERMIT APPLICATION
EI APPROACH Cj PAVEMENT CUT (SEE BELOW) f SIDEWALK
E] CURB & GUTTER El WORK THROUGH MANHOLE ( OTHER
ROAD OBSTRUCTION 1 NO Ej YES (If yes, complete the following)
• % of street or # lanes that will be obstructed:
• Length of time street will be obstructed:
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 tJ Pre-Approved TCP Proposed:
PROJECT ADDRESS: J Ic2.O E. Man1-5vnler, Ave PARCEL NUMBER:
APPLICANT'S JOB#: 133 0J16 LOCATE TICKET# I SJ5ef35S
START DATE: 6-.22_. 5 ANTICIPATED COMPLETION DATE: 6.17 261/5
PROJECT DESCRIPTION: Cenc h /0fff,_ exkr,,J Cv.1Ou.
PROPERTY OR BUILDING OWNER INFORMATION (IF APPLICABLE)
NAME:
MAILING ADDRESS: CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR INNFORMATION L3i j! cat 63ie
NAME: -.J e Into (,,OOCi{y1LAtl i('rci n 5
MAILING ADDRESS:3o1
t nor cl iv CITY: IIa n e Vtl lief STATE: / ZIP: /9.16
PHONE: 509 -53 0'.
.2 - ? FAX:Gil 5041-33,2" 6515 CELL: r^,�r
CONTRACTOR LICENSE NO.: I 11 y 1 EXPIRES: CITY BUSINESS LICENSE NO.: 1r 64 C . 1f t,c Jt
BOND/INSURANCE CERTIFICATE#(per SVMC Title 10, Article 2):
CONTACT NAME: 7ciA firennc.r, • _-_.20C ` c '3 7/_.51
CSV PERMi r CENTER I
ppfJ,U,,,N 1 7 2015
ROW—Vire-
NameProject# W—V ire-
Name r
Modified April 14, 2014 Page 1 of 2
i •• , .•:. -v. I- ..r. .r., 2• • - I ••• 1••• : •• k ' I..
**** IF PAVEMENT CUT, COMPLETE THE FOLLOWING ****
NATURE WORK: Gas Electric Water CATV Communication Sewer Other
(circlee oFne)one)
TYPE OF CUT/REPAIR: Asphalt Gravel Concrete Other
(circle one)
SIZE OF CUT
(width) x (length)
STAFF TO COMPLETE:
ROAD TIER: PAVEMENT CUT POLICY APPLIES?
DISCLAIMER
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 1"and March 31'are valid until the following April 30rn
Applicant Signature: ' Date: �""/7, /r
Method of payment: D Cash D Check ❑ Visa** ❑ 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
L o://www.sookanevaliev.org/filestorage/124/938/210/948/1496/2831/RQW PA.doc
BUFFER DATA
LONGITUDINAL BUFFER SPACE = B
SPEED 0000 25
30
35
40
45
50
55
60
65
10
LENGTH IfdetII l55
200
250
305
-
3 DEVICES MNIYUM SPACED 10.O,C, IN TAPERS Toll
SMOULDER MOTHS LESS THAN 5 FEET
•
-
.
Prbea be va ide mosr.erdsd mry be ■ Mak MWde. Ifs TAA a nal
aw411lt,ee 5re5aee U woos Wles s0abptyf lobbed n aw YIS b
•f 44; burs ea0 ase fab anMS aiubo, a .pbd630
L
SIGN SPACING . x (FEET) (1 )
RURAL ROADS & URBAN ARTERIALS 35/40 MPH 350.6
RRESIURAL ROADS, URBAN ENTTAL & mamas qhs 25 ! 30 MPH meq; (3)
STTHCTg
tlRBAN Sirictf4 25 MPN OR 1503 tart t23
ALL SIGNS ARE 48't 4e" SLACK ON ORANGE UNLESS O. RyWSE
DESIGNATED.
(1) AN soaping may be ad)usted to accommodate interchange rarrlm%.
atgrrde Intersections, and drIveways-
(2) This spacing may be reduced In urban areas to fit roadway
WMMUN TAPER LENGTH . L 11.54
Senldl.
VNdth tell
Poore Spies VnsR)
25 30 33 40 45 50 55 60 65
10
5
54
120 162
1
0
105
150 1204 1270 I. I-
3 DEVICES MNIYUM SPACED 10.O,C, IN TAPERS Toll
SMOULDER MOTHS LESS THAN 5 FEET
CNANNEuziNG DEVICE SPACING (FEET)
L1PN i TAPER TANGENT
35 /40 30
60
25130
20
40
N00.1 1121.5
LEGEND'
SIGN LOCATION
fa
a o a CHANNELIZING DEVICES
CID PROTECTIVE VEHICLE • RECOMMENDED
RECEIVED
CSV PERMIT CENTER
JUN 1 7 2015
roj .+wt -# /�Ry a17/= 20'%m--
arne Zll
ubmitta: #_
NOTES
1. Protective vehicle recommended - may be a work vehicle.
2. When used. device spedng for (he downstream taper should be 20' O.C.
TYPICAL SHOULDER CLOSURE - LOW SPEED (40 MPH OR LESS)
TCP 5