2016, 03-30 Permit App: ROW-2016-0150 ROW Community Development Department
Permit Center (Staff Use Only)
11703 East Sprague Avenue,Suite B-3
Siniorkane Spokane Valley,WA 99206 PERMIT NUMBER:
Tel: 5-01- 720-S2Yo
I.17a11ey Fax: (509)688-0037 PERMIT FEE:
De rmitce nter8 sooka neva l lev.Orq
RIGHT OF WAY (ROW) PERMIT APPLICATION
El DRIVEWAY E` PAVEMENT CUT (SEE BELOW) SIDEWALK
1I CURB & GUTTER j OTHER
ROAD OBSTRUCTION fi NO x=, YES ***TRAFFIC PLAN REQUIRED
PROJECT ADDRE S: 6-01 } S• V N Rowl- (J
T - 'fes• coCOUL 1�1t0833
START DATE: .Lt�S'� (p ANTICIPATED COMPLETION DATE: 41 V I lg
BUILDING OWNER
NAME: ?#f*. ►J
I
NAME: comas�1 Of W"( I/ 344' /�
ADDRESS: 110 YTS'; 4W P *Wei v si :v
Crrv: NI4t STATE: l ZIP: 065-1-i
PHONE: 011✓ eJVpt,' z I FAX: CELL: 1.5. :95 6945q
FD
CONTACT NAME: ittfixic
PHONE: 4i4 FAX: CELL:
CONTRACTOR NAME:y� W I LCo '( loM LLC (,i J I its N)
v-1 V
MAILING ADDRESS: ' ) 21 g. i ' 6- ( i%% ZS -)@f' ' x CO
com
CITY:&Mei STATE: W"f /RC2 n�ZIP: G 10
PHONE:P53 'el I 'PM r �/� FAX: CELL: 15 9 I. 16S
CONTRACTOR LICENSE No.:Pfi,1CT�f4 /4i EXPIRES: l� 1(A CITY BUSINESS LICENSE NO.: CON 41110/IA
TIER:
POLICY:
BOND/INSURANCE CERTIFICATE #:
(PER SVMC TITLE 10 A CLE 2)
SIGNATURE: DATE: 1601
I V
Ri t1U.S tzfP1'�'M67ELE-eoi .0014
****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 Concrete Depth of Gravel:
(preapproved only)
Water
CATV
Comm.
Sewer QW ��p UI '`" •
Other g
Effective October 28, 2007 =_.
Page 1 of 2
C:\Documents and Settings\rw0011\My Documents\Permits\CRy of Spokane Valley ROW apptication.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 tical 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: 0 Cash 0 Check 0 Visa 0 Mastercard
Bankcard #: •
EXP: VIN#:
Authorized Signature:
PLEASE FAX TO CITY OF SPOKANE VALLEY (509) 688-0037 UPON COMPLETION
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Effective October 28,2007 Page 2 of 2
C:\Documents and Settings\rw0011\My Documents\Permits\City of Spokane Valley ROW apptication.doc
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SIGN SPACING •X (1) MI AL= SHOULDER TAPER LENGTH ■113 feet) � $ DEVICE BUFFER DATA
RURAL ROADS S WRSAN MATE S 33 140 1.101 He* MOULDER Posted SFS(R ) MMI j TAPER TN4RRT
RURAL AMOR W W1 ARTMeALO, 21!30 MPH 20VA W WOTM AMO 30 b LONGITUDINAL BLUFFER SPACE B
RESEM:NTIAL S 0011100 COMMpro 25 10 IS N N 50 A 40 4E TO 000 30 N SPEED pave 21 30 A • 0 10 II SO e3 N
WEAN maim 25 MPH OR ISMS WA(3)
(1t ALL SPACING WY 0E A04WOTED TO ACCOMMODATE E 40 40 40 90 liIIDTN ONO /N 200 Ste IM
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TRAWFORTMLE ATTENUATOR 30 FEET MVI.
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