2005, 12-21 Permit App: 05004735 ROW Call 24 hours before inspection required !-4 -( ,
Phone 5(19.688-0195 Fax 509.688-0037
-o -
Siiikane
Valley DEPARTMENT OF PUBLIC WORKS
Anticipated start date 12/21/05 Permit# Account#
ROW CONSTRUCTION PERMIT
LOCATION OF PROPERTY- 4101 S Schafer Rd
(Address/Parcel#, if available)
Applicant Name Avista Utilities Fax 534-2463
Address 1411 E. Mission Ave. Spokane,Wa. 99202— Ann msc46 Phone 509-495-2244
Customer's Name Avista
Address Phone
Contractor's Reg.# Expires
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
nSewer Connection n Driveway
Curb & Gutter Gas Installation/Repair
n Cable/Conduit/Pole n Sidewalk Repair/Construction
n Water Installation/Repair In Other
nPavement Cut Dimensions possible 2x2
Bond/insurance certification must be on file with the City. Bond#
ISPECIAL INSTRUCTIONS): replacing a pole hit by car, east side of Schafer, south of Cimmaron
Job# 834177678
Permittee Signature_AKC Approved Date
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 Date Init
(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