2005, 08-01 Permit App: 05002860 ROW AUG-01-05 MON 03 :22 PM A 5099283474 P_ 03
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APR CO no 14110 FR TO 9283474 P.01/02 n'O
City of # PW16'10
SPDX AN +' VALLEY .�.
UTIf,ITY RIGHT*OTS•-WAY APPLICATION AND PERMIT
PUNIC' WORKS DEPARTMENT Date project starts .6 -1 -0 5-
Date
Date Project ends
APPLICATION
Location of property involved (or address)_________ E. I t'
Nemo of company frara=
Address of company .,tet 'W * hone
p gib 3
Contractors name
Contractors address ,1, G. .__._ phone..g2b - ..4
.5
Contractors registration Number_ ctg9aExpiration date 1/ f 0‘i
Right of Way:
f'AVergeut or sidewalk Intrusive. Yes�, No
Intrusive outside of pavement or sidewullcs. Yes No
Length of cut„____ft. Depth of cut ft. Width of cut ft.
Direction of cot
COAtACt pCrSQA
Address of contact_ *-4)Y.1. r . W f lel 41 Phone
Please explain In detail the description of the activity proposed.,
z)achy authorize the City of Spokane Va11ov urge this permit fee to my charge card.
Visa itlaSterctltlt c P
Phut Heins of balder �nh►R.. 1V\ , Sig:mC ,.,,� Q - -
This document originally contained
zc�SC4r�ti0C1t confidential credit card information which
YermAuetstTemporary was redacted pursuant to RCW 19.255.010
Type of back till to be used: • travel • Crushed CDF and the original document destroyed
pursuant to SOS DAN G52014-030.
riTT6-6PY OF A BOND DIaPOSITEf WITh Tat CITY OF SPOKANE VALLEY ?
A. COPY OF TIE CITY/UTILITY LIAJMITY INSURANCE POLICY MUST BE ON
PILE AT TILL cry,
?ERhir ;II;E 5 . INSPECTION Ott S
App'rCved
Public Works Director Date
CALL 24 HOURS BEFDRS"1NSPECTIONNEEDED
Phone S0,488-0036 Fax . 509-688.0037
PAGE.03
AUG 01 2005 15:23