2015, 08-21 Permit: ROW-2015-0544 ROW Community Development Department
Permit Center (Staff Use Only)
11703 East Sprague Avenue,Suite B-3
Spode Spokane Valley,WA 99206 PERMIT NUMBER:
Tel: (509)688-0036
ValleT
Fax: (509)688 0037PERMIT FEE:
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RIGHT OF WAY (ROW) PERMIT APPLICATION _
If APPROACH J PAVEMENT CUT (SEE BELOW) SIDEWALK
I
CURB &GUTTER 'E WORK THROUGH MANHOLE OTHER
ROAD OBSTRUCTION ® NO ® YES (if yes, complete the following)
• % of street or # lanes that wilt be obstructed:
• Length of time street will be obstructed:
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 REQUIREDEl Pre-Approved TCP Proposed:
PROJECT ADDRESS: 6/5 5, Koren St PARCEL NUMBER:
APPLICANT'S JOB #: I'42-/3`? LOCATE TICKET#
START DATE: �-02y 5 ANTICIPATED COMPLETION DATE: Sf $-2ovS
PROJECT DESCRIPTION: /
t 5e)- ® Poles q/ony f)k -a51 S. of 5 fore„ 5/
ii, obi-4;A bell-fr- GIear*nc2 over 5i-reef F.,,,,- Corneas) Ser✓,`t,e. ay 5'
41/ 5howIZer- Worn"
PROPERTY OR BUILDING OWNER INFORMATION (IF APPLICABLE)
NAME:
MAILING ADDRESS: CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR INFORMATION 8;II ++o Cor1G05)- Cade
NAME: 3€f0 (0r''1 !
1YjuAic�'�i„,I1S d l Valley
km ADDRESS:30)L t1N, Flora ( J CITY: 5,0114 ae Valle/ STATE: � ZIP: 992)
O 1
PHONE: S -53 p3
- �$ FAX: 50 -53.2- D5!5 CELL:
CONTRACTOR LICENSE NO.: 6o 1%2.1141 EXPIRES: a CITY BUSINESS LICENSE NO.: 5EFN61 /67'1911
BOND/INSURANCE CERTIFICATE``# (per SVMC Title 10, Article 2):
CONTACT NAME: ! ocM 18fennG/l PHONE: 20C — (5133- 7959
Raw-Zalf=Q_f 9
77
Modified April 14, 2014 Page 1 of 2
t•• •W• ....11- - - SR. j - •r.■- • • . _1s • : . Lek '•.••,
**** IF PAVEi4NT CUT, COMPLETE THE FOLLOWING ****
NATURE OF WORK:
(circle one) Gas Electric Water CATV Communication I Sewer Other
TYPE OF CUT/REPAIR: Asphalt Gravel Concrete I 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 14 and September 30th 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 314 are valid until the following April 30th.
Applicant Signature: �!i!� Ji'% Date: S;Z°'Za/S
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
tittD://www.sookanevalley.org/fjiestoreag/124/938/210/948/1496/2@ ,t/ROWPA.doc
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MEDIUM TREE TRIM --''f llia I Sag s KAREN RO
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BUFFER DATA
HUM R0A04 t ULSAN mai/ams 30140 12211 3004
LONGITUDNAL BUFFER SPACE = E
URBAN SMUTS 25 NPH 01t LSSO 1081* W
YEW OND
2S
30
35
to
45
50
SS
O0
5S
10
1.01GTN H *an
ISS
200
200
705
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-
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Owl 00 nalshad dShooO N 0000551.
J11611 WA0r110 ■ X (M1) (1 )
HUM R0A04 t ULSAN mai/ams 30140 12211 3004
AWL 00000.UIO101 ARTEMIS =sin WH 2O0a
ROSc0GW. 1 Imams2.0110:1a QI
URBAN SMUTS 25 NPH 01t LSSO 1081* W
ALL merle AIB sr 14' IRACK ON WIN= U41255 0111010M1E
00100NATEIS
(1) uepseirg Mirldaa5U51a4an. saldlfwallys, be Ousted M scoommeade interchange romps,
(2)Thb spacing may b5 Reduced 11 urban areas b 1!t I :May
uNIW WEE IDiGIH s l ONO
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Ihmear
Vidrh (MO
Po05d good 1opg1
33 30 35 b tl 10 9 00 Ir
to
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120
102
210
10
10
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3 OEVICB KNOW 522.12D 100.3. 51 TAPERS
1113011381 2501)10 LESS 71NN 5 FEET
5011
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TAPst
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25130
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LOCATON
DEVICES
PROTECTIVE VISOCLE •RISr00W910EO
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NOTES
1. P nrid w YsRId5 ro amlerded - may IIe a =Mr Wilds.
2.WMp1 wed, dNAaS Spacing Oxen do/mare= taper Shad 2U .C.
TYPICAL SHOULDER CLOSURE - LOW SPEED (40 MPH OR LESS)
TCP 5
ROW -701
F75
0