2004, 11-12 Permit App: 04009061 ROW C
0(0 1
40"\ftlig Celt 24 hours before inspection requked
Thom 509.688-0036 Fax 509_688-0037
*awe
40.0Valley DEPARTMENT OF PUBLIC WORKS
Anticipated start date Permit#PW
' ROW CONSTRUCTION PERMIT
Location of property 4ffir 3 (-�Mdr s/Parcel#, If available)
Applicant Name,���. kg. 'eI
Address 3P-D-- T . Phone e99
Contractors Name r • •
Address Phone 9.7.4
contractors fi .--- "os
P_Ru EC p DESCRIPTIQ ((Provide site sketch or plan as necessary for clarity)
aSewer Connection E Driveway
�� fl Gas Installation
[] Cableiroildult Sidewalk RepairiCousbuctionBoodAnsurence certification must ❑
be withthe City_Bond*
SPECIAL coMomoN
Permittee Signature Approved
I herebyauthorlm the City of SpokaneIs MO*theme the feeborit&ppb nry audit cad.
6a�ira8on Dela
Cardf
Harm of holder
Dateparmatinlit
Fees Paid$ ction)
(AA(Application) (inspection)
F0
In addition to the permit application fee of$18.00 or$25.00,inspection on each permit will be
• billed to the permltte►e at a rate of$50.00 per hour with a$25.00(112 hour)minimum.Permittee
signature on permit constitutes an agreement to these terms and provisions.
Work completed satisfactorily(Signed) Date
.. •. . ..III _...alt 11*..f'owli 11InNiffmatinn Tie•1,At s entered here