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2014, 09-24 Permit App: ROW-2014-0521 ROW ; 0: iILthD ' c�kAL__X14.----052.1 t RECEIVED Community Development Department Permit Center {gaff Us vly) 11703 East Sprague Avenue, Suite 8-3 ,Cr''_CC Spokane valley,WA 99206 PERMIT NUMBER:SiSokane Tel: (-501)688 08e6' Soot- 72o-S2 'o Fax: (509)688 0037 I T C E N T E f� ��� oerValleYmitcenterC6'ssookanevallev.orq RIGHT OF WAY (ROW) PERMIT APPLICATION DRIVEWAY EPAVEMENT CUT (SEE BELOW) ` SIDEWALK E CURB & GUTTER OTHER RMI ROAD OBSTRUCTION gNO YES ***TRAFFIC PLAN REQUIRED PRO]ECT ADDRESS: 159,92 £ i 44' 36 /L9 9 START DATE: /t/i fry ANTICIPATED COMPLETION DATE: /O/J/5 BUILDING OWNER NAME: NAME: £Li1761_5% Pr- ADDRESS: % Jct el&/F Y A-Li& A A, BG Y _3•7"-&--/Z CITY: Pa-11/1-GI—Lt 0 STATE: L.3 A 37 3 �7 PHONE: 253 £1.V-416_7, / FAX: CELL: ZS 7. illi` 32d J CONTACT NAME: To ynv2L/s PHONE: ,26,(-1"1,33 FAX: CELL: CONTRACTOR NAME: ?2/,t1�� / LE�n r c Lem 2_yq-A.) /L-,&.E/f--1n,/ MAILING ADDRESS: /370 / 1V-e6 1 A 1 /�O p �} CITY: ..�L/yj-7 d 1 —� STATE: [),4- 7 ZZIP: % 5 / D PHONE: 2,.�r3.g1/-Z1''Z S 9 FAX: ��291 r Z/CELL: 5 2i / af 2 'L CONTRACTOR LICENSE NO.:&/,J a'�'1 9/ T Ex/ EXPIRES: /1�+k CITY BUSINESS LICENSE NO.: /D/ 9 94,'/V2 TIER: POLICY: • • BOND/INSURANCE CERTIFICATE #: (PER SVMC TITLE IO TICLE 2) /^ SIGNATURE: , G / e,r DATE: 940./1 ****MUST BE COMPLETE IF PAVEMENT CUT**** TYPE OF WORK CONDITION OF CUT TYPE OF EXISTING ROAD CONDITION REPAIR Gas Sawcut Asphalt Depth of Asphalt: Electric Grind Concrete Depth of Gravel: (preapproved only) Water CATV Comm. Sewer Other Effective October 28, 2007 Page 1 of 2 r•lnrrvmanhe anrd Cai+innclnediM 11M*, nnur Asphalt (width X length) Concrete (width X length) Locate Ticket#: X X X X X X X X X X X X DISCLAIMER 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 Inure 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. Signature Date: r Method of pa eat: 0 Cash 0 Check 0 Visa 0 Mastercard Bankcard #: EXP: VIN#: Authorized Signature: PLEASE FAX TO CITY OF SPOKANE VALLEY (509) 688-0037 UPON COMPLETION ___1?)?) - Pr/D.6 Cle-EA) rizE,f)2/715L)ek Jt) .21Ze) ei 41, z "ae z.--/ //fe-A_Aei-/ z1/4-7V &cOF LS-7s560-11, 72,1-7.02-71 3bc. z)F I -7cYr T 7774L—.4) 1)1)&7? 14-L4 Zo4.)-7-J,L.).ae ei_.) 77717-Ec—x_ie1-1 L9-(e 77-1 jz."' r 9L q " MOLY'i_)7. )1/7 Effective October 28, 2007 Page 2 of 2 C:\Docunients and Settinqs\rw0011\My Documents\Permits\City of Spokane Valley ROW aoolication.dnr 0 ,.,, .,, .... . . . . , ,..... . ........, . . .. .,.,... . ., :!..::.' .......'-,4...'„' .. ..'-. . ...:1.J...:...:0.,:.,.-.;`,-.':-,---„, .,, --'-1- -; --'-... ,....' :-4. . ,,,,, 16701 11 11 th Ave •.,..''. ••,..,:;:: ,.: ' . 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