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2015, 08-27 Permit App: ROW-2015-0557 ROW RECEiVED CSV PERMIT CENTER AUGL 2015 Community Development Department 1'(n eCt _ Permit Center (Staff Use Only) 11703 East Sprague Avenue, Suite B-3 Spokane Valley, WA 99206 PERMIT NUMBER: iO [v7� /-0 1 ►r� Tel: (509) 688 0836 59'1- 720-SZYo u� {� Fax: (509) 688-0037 PERMIT FEE: permitcenterAspoka nevalley.orq RIGHT OF WAY (ROW) PERMIT APPLICATION ❑ DRIVEWAYPAVEMENT CUT (SEE BELOW) ElSIDEWALK ❑ CURB & GUTTER OTHER ROAD OBSTRUCTION ❑ NO ❑ YES ***TRAFFIC PLAN REQUIRED PROJECT ADDRESS: .q' `s• 13Y6q-e6 gyp• -s/O ASE VPrL-L C) /(91 71.9- START ANTICIPATED COMPLETION DATE! 4 15- BUILDING OWNER NAME: NAME: etMAfr� ST Of )/q ADDRESS: APOV/'<1*- V( /E /1/4.1tnl. 13176 C' t Te. (2- �y Q CITY: MA l-t k1! STATE: h4.<- ZIP: � ✓��3 PHONE: 23• �� L� - 4 b I FAX: CELL: 0 . 1�J✓te •a20(%) CONTACT NAME: � (- O1I5 PHONE: � i�/ 92(n4 � FAX: CELL: CONTRACTOR NAME: r/FX 72LL%Co#J LLG IzA.!A-N W 1 I I' - -OrJJ,, a� c;94-Ms-CT- �/• .Ow61 • IN K O•V311 r �r`1 COTE MAILING//,,A''DDRE1SS: �j'q� C/�0��, Cm: 661.410 ( QQy /� STATE9/W ZIP: e'. 40 C01( PHONE: •c/ 1 1 • v 7/p�e! FAX: - .0q1.47/(� CELL: /�[� /,� CONTRACTOR LICENSE No.: T 731�-(� EXPIRES: Sl i U l 1 CP CITY BUSINESS LICENSE NO.: 0Q/"/ I 4'49 TIER: POLICY: _ BOND/INSURANCE CERTIFICATE #: (PER SVMC TITLE 10 RTICLE 2) SIGNATURE: DATE: 649-411 S— ****MUST BE COMPLETE IF PAVEMENT CUT**** TYPE OF WORK CONDITION OF CUT TYPE OF EXISTING ROAD CONDITION REPAIR Gas Sawcut Asphalt Depth of Asphalt: Electric Grind (preapproved only) Concrete Depth of Gravel: CAT 61t.cWC1J'f tiSIAVR -re?2 Comm. Sewer Other Effective October 28, 2007 Page 1 of 2 C:\Documents and Settings\rw0011\My Documents\Permits\City of Spokane Valley ROW application.doc Asphalt (width X length) Concrete (width X length) Locate Ticket #: X X X X X X X X X X X X 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 inure 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. Signature Date: Method of payment: ❑ Cash ❑ Check ❑ Visa ❑ Mastercard Bankcard #: EXP: VIN#: Authorized Signature: PLEASE FAX TO CITY OF SPOKANE VALLEY (509) 688-0037 UPON COMPLETION 1. `f 5 ' FOS ec \N _p&p f Pc 1 1 cFcAJ T- o .p<-r-Tpctk . Effective October 28, 2007 Page 2 of 2 C:\Documents and Settings\rw0011\My Documents\Permits\City of Spokane Valley ROW application.doc 45 ft Road Bore w/asphalt cut over existing utilities in rd. Existing Jump Ped 45 ft Road Bore Possible Asphalt cut (utilities) Existing Ped Sates Existing CAN Main 3617 CoMC T (ft#. /of 8/27/2015 3617 S Bates Rd-Google Maps A'//•'• '//? ® � 3617 S Bates Rd '1 ik--..*,,•'' L........ 'a°.'-� :x* ^s+ C ass 7 E -„,.....,..,;,...,,,,t a i? s*T • �"" ",� ca e.,7,..ti,..*'" 7:„ylia.'-'77:z,.,...,,,, 7-.;...,..,-•'-‘,*..•i r ,,.., ,,,,.., , ,z„,„,,,,,„, .. . , ,1 �. �•� Fir" � � � a. � iii ,.,, ' ,.„ ff 1 ,, I, .',„,•-',,. t..4.0 et,s,„...;.,•:.1t-ft•- •••. , _ „,, 0 t, , ,e, , . ., T ""'�y, k` ,. 1a I 3617 S Rata''. ' -!. ' - I -71 h tt„i°,-. .-,,•••'-,iiiii- ,,i',.;11M•;:-'" ',15" u ''' ..,. f % ' Rd r) is _ r _. rF a � .tel+ ?.. ' `" `-". ""`- ' �'x °\, c .RAN2+.. d ar Imagery©2015 Google,Map data©2015 Google 50 ft https://www.google.com/mapslplace/3617+S+Bates+Rd+Spokane+Val!eV+'^!c•:�2uaL47.6233724,-117.2491051,119m/data=!3m1!1e3!4m2!3m1!1s0x549e... 1/1