2014, 12-15 Permit App: ROW-2014-0697 ROW • • # 1/ 2
12-15-14; 10: 13AM;
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Community Development Department
▪ ■ Permit Center (Staff Use Only)
■ i 1703 East Sprague Avenue, Suite 8-3
stiokane Spokane Valley, 03 99206 PERMIT NUMBER:
Tel: (509) 688-0036
Valley.000Fax: (509) 688-0037 PERMIT FEE:
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RIGHT OF WAY ROW) PERMIT APPLICATION
❑ APPROACH LI PAVEMENT CUT (SEE BELOW) ❑ SIDEWALK
❑ CURB & GUTTER ❑ WORK THROUGH MANHOLE ❑ OTHER
ROAD OBSTRUCTION Pr NO 0 YES (If yes, complete the following)
• % of street or # lanes that will be obstructed:
• Length of time street will be obstructed:
q If work closes more than 50% of a local access street, or closes any portion of an arterial street,
then a TRAFFIC PLAN XS REQUIRED ❑ Pre-Approved TCP Proposed:
PROJECT ADDRESS: 13310 ,. 4/77/ PARCEL NUMBER:
APPLICANT'S]OB #: LOCATE TICKET#
START DATE: /Z. /S /c�/ ANTICIPATED COMPLETION DATE: /Z7/9// 5/
PROJECT DESCRIPTI N:
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PROPERTY OR BUILDING OWNER INFORMATION (IF APPLICABLE)
NAME:
MAILING ADDRESS! CITY: STATE: ZIP:
PHONE: FAX! CELL!
CONTRACTOR INFORMATION
NAME:VERA WATER&POWER
MAILING ADDRESS: PO Box 630 CITY:SPOKANE VALL STATE:WA ZIP:99037
PHONE: 509)924-3800 FAX:(509)922-3929 CELL:
CONTRACTOR LICENSE NO.: EXPIRES! CITY BUSINESS LICENSE NO.:
BOND INSURANCE CERTIFICATE# •er SVMC Title 10 Article 2 :
CONTACT NAME:TODD HARMON • - •. • I924-3800
Project #tO .W- ?-o/ 4_-U6R
RECEIVED
DEC 1 5 201 ;
CSV PERMIT CENTER
Modified April 14,2014 S U Bc Page�ef
Users h-rm•i V : . •. men s S••k- - V. - �� ,,,� •.c! `- 1
Received Time Dec. 15. 2014 10: 14AM No. 1337
12-15-14; 10: 13AM; # 2/ 2
**** IF PAVEMENT CUT, COMPLETE THE FOLLOWING ****
NATURE OF WORK: Gas Electric Water CATV Communication Sewer Other
Scheie one)
TYPE OF CUT/REPAIR: Asphalt Gravel Concrete Other
(circle one)
SIZE OF CUT
(width) x (length)
STAFF TO COMPLETE:
ROAD TIER: PAVEMENT CUT POLICY APPLIES?
DxscLAIMER
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 inures 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 local laws, codes or ordinances. 6) Plans or additional
Information may be required to be submitted and subsequently approved before this application can be processed,
EXPIRATI9N
Right-of-way permits Issued between April 10 and September 301h are valid for 30 days after the date of Issuance, with a one-time 30-day
extension available. Right-of-way permits Issued between October 10 and March 31"are valid until the following April 30th.
Applicant Signa -• — Date:
Method of payment: ❑ Cash ❑ Check ❑ Visa** 0 Mastercard**
** If paying with credit card, the City will call for credit card Information when the permit is ready to be issued.
PLEASE FAX TO CITY OF SPOKANE VALLEY (509) 688-0037 UPON COMPLETION
Modified April 14, 2014 Page 2 of 2
C:\Users\tharmon VER„4 P\Documents\$ookane Valley ROWPA doe
Received Time Dec. 15. 2014 10: 14AM No, 1337