2006, 01-04 Permit App: 06000021 ROW 61/03/2006 13: 41 5097559066 MODERN ELECTRIC PAGE 01
MAR 25 2003 13:07 FR TO 7559000 P.02/02
•
City of PERMIT # PW �0
A
SPOKANE VALLEY
UTILITY RIGHT-OF-WAY APPLICATION
AND PERMIT
PUi LIC WORDS DEPARTMENT
.AITLICATION
Location of property Involved (or Address) /"7/L Kt-4'47Y ,Q��v.E
Name of company • 1 . _ C t ,'T`R C,0J1ellt)y
Address of compnny1O 3QX Tubo$ SPOKANE JAL +_kI1 1921'I phone 92S-y5110
Contractors naanc
Contractors addtcs phone
Contractors registration Number- Expiration date
Right of Wily:
Pavement or sidewalk intrusive. Yes No
intrusive outside of pavement or sidewnllcs. Yes ✓ No
Length of cut y ft. Depth of cat V ft. Width of cut ft.
Direction of cut
Contact person 1)/40iUSor✓
Address of contact Phone
Please explain in detail the duticrlption of the :sctivity proposed_ Eit-fMC.,E/1it%//
I hrrchy■nthorlre the City of SpainValley to charge the ire for this permit to my cr.rltt c.r&t
Viiu hfatterctist.Ec ---- ---- —!—` _^_
Print nirne of ItoCh r Sign aritrc
PERMIT: Sp-ecial Conditions
Rertoration: Perm adult Tunpore y _
Type of hick Mita to be aced; ;ray.l ernaLea CM?
IS A COPY OF A 1IONf DEPOSITED WTrli TIlE CITY OF SPOKANE VALLEY?
A COPY OP TILE CITY I to heli' f.IA1lIixry ENS UIRANCE POLICY M17ST BE ON
FILE AT TIlE CITY. K
PERMIT FEE ; INSPEC 1'ION FEE S
Al,provud
Pu Vorky Director [irate
a4:11,2,1 11017RS BEFORE INSPECTION NEEDED
1'horr 509-688-0036 Fax 509-648-01137
R-U- 'nPP.
43K TOTPL PPGE.C2 **
JAN 23 222E 14:05 5097559202 PAGE.01