2015, 08-14 Permit App: ROW-2015-0526 ROW Community Development Department
Permit Center (Staff Use Only)
ilTYa 11703 East Sprague Avenue,Suite B-3 ane
Spokane Valley,WA 99206 PERMIT NUMBER:
Val Tel: (509)688-0036
�• Fax: (S09)688-0037 PERMIT FEE:
permttcenter�ilspoka nevalley.orq
RIGHT OF WAY (ROW) PERMIT APPLICATION
APPROACH � PAVEMENT CUT (SEE BELOW) ! SIDEWALK
CURB&GUTTER l'•J WORK THROUGH MANHOLE tIl OTHER
ROAD OBSTRUCTION ® NO IX YES (if yes, complete the following)
JC` • Cain 1lAn fa • % of street or # lanes that will be obstructed: /0090
• Length of time street will be obstructed: S
c* 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 Q Pre-Approved TCP Proposed:
PROJECT ADDRESS: 501 S, (cIon RC! PARCEL NUMBER:
APPLICANT'S 30B#: 13532/ LOCATE TICKET# AM
START DATE: / . - ANTICIPATED COMPLETION DATE:
PROJECT DESCRIPTION:
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PROPERTY OR BUILDING OWNER INFORMATION (IF APPLICABLE)
NAME:
MAILING ADDRESS: CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR INFORMATION Bi II 10 Loi cast- 631e
h/e
NAME: •Sefnco Co^�n�un:ca'lens
MAILING ADDRESS:301! Al. F1orc, j cm': _5e/cane VAIle/ STATE: WA. ZIP: 992/6
PHONE: SO -53.2 - e3o$ FAX: 501-53.2- &5J 5 CELL:
CONTRACTOR LICENSE NO.: 6QJ'01 1 ILI 1 EXPIRES: I CITY BUSINESS LICENSE NO.: SEF/ill 1 *yC/y 1
BOND/INSURANCE CERTIFICATE#(per SVMC Title 10, Article 2):
CONTACT NAME: /c,ciA _- nnn_ PHONE: .206 ` 6S3- 7957
ROV 7.0/3-- 52
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Modified April 14,2014 Page 1 of 2
•: L L. .1 - • • 1 •r.•' • • - 1 ..• '•• : :41 00,.
**** IF PAVEMENT CUT, COMPLETE THE FOLLOWING ****
NATURE OF WORK: Gas Electric Water CATV Communication Sewer Other
(circle one)
TYPE OF CUT/REPAIR:
(circle one) Asphalt Gravel Concrete Other
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) Alt 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't 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 30th,
Applicant Signature: �i�% i� Date: 6-/y 2o/'-
Method
Method of payment: 0 Cash 0 Check 0 Visa** 0 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
htto://www.spokanevaliev,org/filestorage/124/938/210/948/1496/2831/ROW PA.dot
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BUNDLE ONYETER: 1.021'
WEIGHT: 0.296 LES/FT -- _
PROP. CMC CLEARANCE
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501 1/2 CARNAHAN
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Cay: SPOKANE
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Stale:WASHON
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Job Numb.f: 135321
Folded by: INE MINER
Phone: (509)532-5308 Cat(509)342-032
Dosigmd by: J. HUMORS
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16'-11• CUM( (N -S)
16'-1• CAW DROPS
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CMC: LOWER 1'-9" 70 21'-6'. R£WOJE. 3 DROPS
TO POLE 12
CLNN. REMOVE ABANDONED DROPS
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NOTE: PERMISSION R NEEDED fRCN CUNK TO
MOONY ATTACHMENT ON POLL.
£,vrsrA APPROVED
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DATE
11/24/14
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