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2003, 06-24 Permit App: BD03-403 ROW City of PERMIT # PW 3'- SPOKANE VALLEY UTILITY RIGHT-OF-WAY APPLICATION AND PERMIT PUBLIC WORKS DEPARTMENT APPLICATION b Location of property involved (or address) g0 Name of company D C u RC\1 n E c_01-‘%% Address of company 19 gig g, spfkagUe_ phone 9a1-511 S*5- • Contractors name u ai,n C 0 u � e l � Contractors address 19541% 6 $ phone q -g-R5- ,,Contractors registration Number C-O UIC C 1 glC, $ 1 Expiration date I v—03 Right of Way: Pavement or sidewalk intrusive. Yes No Intrusive outside of pavement or sidewalks. Yes No Length of cut ft. Depth of cut ft. Width of cut ft. Direction of cut Contact person 3116e. L1,tt2 L.K. Q(..,4_% \Q C.,© AK& I 0 Q.— Address of contact 19 R( $` E; S c,�Rt(,,l E_ Phone 92(1-54 4 2'$ Please explain in detail the description of the activity proposed. I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card: Visa Mastercharge Print name of holder Signature PERMIT: Special Conditions Restoration: Permanent Temporary Type of back fill to be used: gravel crushed CDF IS A COPY OF A BOND DEPOSITED WITH THE CITY OF SPOKANE VALLEY ? A COPY OF THE CITY/UTILITY LIABILITY INSURANCE POLICY MUST BE ON FILE AT THE CITY. PERMIT FEE $ j(a,07 INSPECTION FEE $ Approved Pp. . Q X1)3 Public Works Director Dat CALL 24 HOURS BEFORE INSPECTION NEEDED Phone 509-688-0036 Fax 509-688-0037 ID A El MR—O- W APP.