2004, 05-21 Permit: ROW-04-00331 ROW Call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
CITY
kane
Valley
DEPARTMENT OF PUBLIC WORKS
Anticipated start date Permit# 04-331 Account#
ROW CONSTRUCTION PERMIT
Location of property 911 N. Van Matter Rd.
(Address/Parcel#, if available)
Applicant Name Diamond Rock Construction Inc Fax
Address 15321 E. Mission Ave. Spokane Valley,Wa. 99037 Phone 509-924-8964
Contractor's Name
Address Phone
Contractor's Reg.# DIAMORC032OQ Expires 8-12-2004
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
ElSewer Connection In Driveway
n Curb & Gutter Gas Installation/Repair
❑ Cable/Conduit/Pole ❑ Sidewalk Repair/Construction
❑ Water Installation/Repair ❑ Other
ElPavement Cut Dimensions
Bond/insurance certification must be on file with the City.Bond#
SPECIAL CONDITIONS: Construct driveway approach per Spokane County Standards as
adopted by the City of Spokane Valley.
See attached Provisions
Permittee Signature Approved G Date, r7
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card# Expiration Date
Name of Holder Signature
Fees Paid$ 25.00 25.00 Date !nit
(Application) (Inspection)
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
Permit not valid until One-Call Notification Ticket#entered here
PERMIT MUST BE KEPT ON SITE