2003, 06-30 Permit App: ROW-03-00423 ROW City of ' PERMIT # PW 1-1�3
SPOKANE VALLEY
UTILITY RIGHT — OF— WAY APPLICATION AND PERMIT
PUBLIC WORKS DEPARTMENT Date project starts
Date Project ends
(Please call for final inspection)
APPLICATION
Location of property involved (or address) —7(4 b 9 i. (231-
Name
2Name of company ‘c,4S Ce,. s i—
Address of company cpjev,,v C j • - phone Q S?.9.-7 733
Contractors name C, ,W c e. 1—
Contractors address 11.0s—Z.0 k . S A,- 4" phone Qq
9—7? 33
Contractors registration Number C.10-4)-- -c.,'1,0.4 ( Expiration date 11--0(1
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 C4,Tc-re
Address of contact Se„y.N.e.. Phone 411%7733
Please explain in detail the description of the activity proposed. ctv--We GU !
C reel- ( Z4-'` -
I hereby authorize the City of Spokane Valley to charge this permit fee to my charge card.
Visa mastercharge Valid Date
Print name of holder Signature
PERMIT:
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 $ INSPECTION FEE $
Approved
Public Works Director Date
CALL 24 HOURS BEFORE INSPECTION NEEDED
Phone 509-688-0036 Fax 509-688-0037
R-0- W APP.