2015, 04-20 Permit App: ROW-2015-0185 ROW 04-20-15;08:27AM; # 1/ 2
Community Development Department
all:: Permit Center (Staff Use Only)
SiTio 11703 East Sprague Avenue, Suite B 3
Spokane Valley, WA 99206 PERMIT NuMBeR:
� Tel: (509) 688-0036
Valley• Fax: (509) 688-0037 PERMIT FEE:
germ itcenterf�woka nevallev,orq
RIGHT OF WAY�OW) PERMIT APPLICATION
0 APPROACH Q/ PAVEMENT CUT (SEE BELOW) ❑ SIDEWALK
❑ CURB & GUTTER El WORK THROUGH MANHOLE ❑ OTHER
ROAD OBSTRUCTION EeNO ❑ YES (If yes, complete the following)
• % of street or # lanes that will be obstructed:
• Length of time street will be obstructed:
b If work closes more than 50% of a local access street, or closes any portion of an arterial street,
then a TRAFFIC PLAN IS REQUIRED ❑ Pre-Approved TCP Proposed:
PROJECT ADDRESS: 11/603 6 7 PARCEL NUMBER:
APPLICANT'S JOB #: LOCATE TICKET#
START DATE: '-r!/i7/1' ANTICIPATED COMPLETION DATE: q/2,3//5
PROJECT DESCRIPT ON: Emtere_ zep4(Q._ 0,F0A c-�- (JA
�L6-crrie(� S ,ac)lc- .
PROPERTY OR BUILDING OWNER INFORMATION (IF APPLICABLE)
NAME:
MAILING ADDRESS: CITY: STATE: TIP:
PHONE: FAX: CELL:
CONTRACTOR INFORMATION
NAME:VERA WATER&POWER
MAILING ADDRESS: PO BOX 630 crrv: 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# (per SVMC Title 10, Article 2):
CONTACT NAME:TODD HARMON PHONE:(509)924-3800
—
t
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. 04-20-15; 08:27AM; # 2/ 2
•i
**** IF PAVEMENT CUT, COMPLETE THE FOLLOWING ****
NATURE OF WORK: Gas 412PPWater CATV Communication Sewer Other
(circle one)
TYPE OF CUT/REPAIR: •sphalt Gravel Concrete Other
Sclrcle one)
SIZE OF CUT I r
width x Ien•th 54 O
STAFF TO COMPLETE:
ROAD TIER: PAVEMENT CUT POLICY APPLIES?
DISCLAIMER,
The permitted verifies,acknowledges and agrees by their signature that: 1)If this permit is far 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.
EXPIRATTTION
Right-of-way permits Issued between April 1st and September 301" 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 1`"and March 31st are valid until the following April 30`h.
Applicant Signature: 7.- .'
Date: 1 //,..5
Method of payment: ❑ Cash ❑ Check ❑ Visa** ❑ 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
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Received Time Apr, 20. 2015 8: 24AM No. 1757
P. 1
* * * Communication Result Report ( Apr. 20. 2015 10: 19AM ) * *
1) Spokane Valley Permit Center
2)
Date/Time : Apr, 20. 2015 10: 18AM
File Page
No. Mode Destination Pg (s) Result Not Sent
1759 Memory TX 99223929 P. 2 OK
Reason for error
E. 1) Hang up or line fail E. 2) Busy
E. 3) No answer E. 4) No facsimile connection
E. 5) Exceeded max. E—mail size
City of Spokane Valley
e ...e Community Development
t1
!ty'LE 11707 E.Sprague Ave..Suite 108
11�'. Spokane Valley.WA 69206
(609)720-6240
.. .. .. permitpenter®sonkanevallev,Orq
ROW-2045-0185 DE-ROW
PROJECT NAME: ISSUED:04/2012016
SITE ADDRESS:14603 E 7TH SPOKANE VALLEY EXPIRES:
PROJECT DESCRIPTION:EMERGENCY REPAIR OF UNDERGROUND ELECTRIC SERVICE
PARCEL:45232.0011
APPLICANT VERA WATERS POSER-INVOICE OWNER: VERA WATER d POWER-INVOICE
PO ROY 930 VERAOALE,WA02037 PO 60X 630
5098223920 VERADALE,WA99037
590-9223029
OWNERACTPIG AS BUILDER: VERA WATER 9 POWER !keno:OWNER
PO 605 030 Expires:
VPRAOALE.WA 69037-0530
FEES: Sold Due
Right of Way 3168.00
Totsle: $160.00
CONDITIONS
•Prior to excavation,it is the Contractor responsib10ty to contact the purveyor of any transmission pipeline tat Is wlifn 100
feet of pendted wort es per RCW 19.122.031-
•For walk blocking less than 50%of a local access street the contractor,eta Manure,Ls required to have Construction
Ahead signs placed ahead of the wort zone.Note—if i1 turns eel hat the work blocks more than 6096 of a local 006610
street then the parfait 1.9 not valid and the contactor must submit a traffic control plan to the City for reviewfacceptance prior
to cenfomance of the work.Al traffic control shall folksy MUTCD standards.
••Far pavement cul,as-built drawings(using the oaieut Inland Northwest Regional Pavement Cul PCOry template)are
muted to be submitted to the Right-of-Way Inspector,Scott Wallace,wihin 15 working days of work being Completed.As-
butte shall be suisintied by mat(10 swateceespokenevnley.org),by Fax(506-921-1006)or by dropping o6 et he Permit
Centex
"AI pavement cuts valhin the City of Spokane Valley right-of-way shall comply with the current adopted Inland Northwest
Regional Pavement Cut Patsy,or as amended.
•AI pavement repairs shat be inspected by the City's ROW inspector,Scott Wallace(mobile:506.5695373).The
Contractor shat notify Mr-Wallace a minimum 0024 hours In advance of he paving.
me by:PandrMies ona0a8alb laiOAN 0 151 M2