2016, 03-14 Permit: ROW-2016-0104 ROW —•U 14/lb Ul: 5iYt1 t11 LAbLEOLI rAX p. Ul
I•• 011 // 10 Ct
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le
Call 24 bouts before inspection required
Phone 509.688-0036 Fax 509.688-0037
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DEPARTMENT OF PUBLIC WORKS
Anticipated start date "3/4.oe /7 Permit # PW
ROW CONSTRUCTION PERMIT
Location of property iiii.,g2 V 4 4
(Addy ss/Parcel#, if available)
Applicant Namelil.e',/. e00'frit ...Lgteoes461 #,
?Address 150 L , !c' hii Phone.......
Contractor's Name
Address)to 9 5 ovs ►st , tg- '4. 99,2n Phone s`°9•tc&11/43' CC)
Contractor's Reg# iJeteite ,, '17J12- Expires a01. 1 i
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity) _s,
Sewer Connection jDriveway
1 Curb & Gutter µ Gas Installation
] Cable/Conduit Sidewalk Repair/Construction
Other Wier Service. j epfttee-- goer m'ito" 0/
Pavement Cut? Dimensions
Bond/insuranca certification must be on file with the City. Bond#
„—
SPECIAL
SPECIAL CONDITIONS:
Permittee Signature '' ;'�,.�r-- Approved
I hereby authorize the C y of Spokane Valley to charge the fee for this permit to my credit card, M -
Card# Expiration Date
Name of Holder Signature
Fees Paid$ Date !nit
__.._...,_....,...,....,........_._._.._...._. ._....,.(1 pRii in)_-_ .._....(tn..p. xionnl--......................... —
In addition to the permit application fee of$16.00(utility)or$25.00 (construction), inspection on
each permit will be billed to the permittee at a rate of$50.00 per hour with a $25.00(1/2 hour)
minimum. permittee signature constitutes an agreement to these terms and provisions.
Work completed satisfactorily(Signed) Date
Received Timei'Mar. 14. 1 2016( 1 : 39PMmo, 30 6 3an Ticket#entered here
PERMIT MUST BE KEPT ON SITE