2007, 11-14 Permit App: 07004569 ROW From Vicky to Anyone at Wed 11/14/2007 6:22 PM 2/2
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, Permit Center PERMIT NUMBER: t4 /
11703E Sprague Ave,Suite t3-3 ~' 1
,000\411w Spokane Valley.WA 99206 PERMIT FEE: r-5-
(509)688-0036 FAX:(509)688-0037
Community Development
ROW Construction 0 Driveway LJ Pavement Cut "(see below)
Permit Application ❑Sidewalk 0 Curb & Gutter ❑(Ober
0`6 2 0 Road Obstruction El No ❑ Yes(traffic control plan required)
AIWA •7
START DATE/7, l6 ( 944 //J ANTICIPATED COMPLETION DATE //- /6( 7/4-*--�)
Building-tO�wner: Contractor: /
Name: , t r� x fi'L'° r l t tt QT Name: �+�( l k2c)
Address: / ,tv Address:
C1tY: 4 I . • State: Zip:c` `. Cit: State: • Zip: '
Phone.
�1�?'��-/S/ / Fax: Phone:�r'.�.Q'".;rJ�-; Far:�r�;2•
Contact Person
Contractor Lie N ,/¢J73,S1, ,Exp Dote: /6 •.G,�S
Name -7)41,
11
'i � � - City Business Lic.No: ,j, 3 � = ,9G>.�
Phone: y
Tier
Policy
**MUST BE COMPLETE IF PAVEMENT CVT**
Type of Work Condition of Cut
Gas Sawcut
Electric Grind 1pre-approved only)
Water
CATV
COMM unci Cations
Sc c r
her . /1:c_.r
Type of Repair Pristine Road Condition
Asphalt Depth of Asphalt
Concrete Depth of'Gravel
Asphalt Concrete Locate Ticket#
Width Length Width Length
x
x x
x X
BOND/INSURANCE CERT#t/tea )4 (PER SVMC TITLE 10 ARTICLE 2)
Signature Zi�..e.44i?�: ; � 4 c.i Date //�
Method of Payment:
Cash 0 Check 0 Mastercard 0 VISA
Bankcard#: Expires: VIN#:
Authorized Signature:
Work completed satisfactorily Date
(INSPECTOR)
PLFASF PAY TO CtT,or crate-Aug vAI.L.CY Yr-ON cGMr'LCtiOri(003)000'OU3T
IFC 7CtD ta:wc
PAGE.02
NOU 14 2007 16:24
From Vicky to Anyone at Wed 11/14/2007 6:21 PM 1/2
F x
Note
To From
Anyone Vicky
Company Company
City of Spokane Valley Stehlco L. L. C.
Fax Number Fax Number
688-0037 (509)928-7735
Phone
(509)928-7735
Address
12111 E. Valleyford
NOV 14 2007 16.24 PAGE.G1