2015, 05-07 Permit App: ROW-2015-0238 ROW 05-06-15;03:40PM; # 1/ 2
Community Development Department
Permit Center (Staff Use Only)
ScrryoF 11703 East Sprague Avenue, Suite B-3
poke Spokane Valley, WA 99206 PERMIT NUMBER:
Tel: (509) 688-0036
Valley Fax: (509) 688-0037 PERMIT PEE:
pax: (5 enterPsnQkanevallev,org
RIGHT OF WAY ROW PERMIT APPLICATION
❑ APPROACH a PAVEMENT CUT (SEE BELOW) ❑ SIDEWALK
❑ CURB & GUTTER ❑ WORK THROUGH MANHOLE ❑ OTHER
ROAD OBSTRUCTION LNO ❑ YES (if yes, complete the following)
• % of street or # lanes that will be obstructed:
• Length of time street will be obstructed:
Ea If work closes more than 5O% of a local access street, or closes any portion of an arterial street,
then a TRAFFIC PLAN IS REQUIRED ❑ Pre-Approved TCP Proposed:
PROJECT ADDRESS: .5 (ct 6 Z-74' PARCEL NUMBER:
APPLICANT'S JOB #: LOCATE TICKET# Z 75k
START DATE: .S LT S ANTICIPATED COMPLETION DATE: SM 5
PROJECT DESCRX`T ON: Em 6 6 Y r 317-6,1e_. 1 Ai 4J ' E p//(
PROPERTY OR BUILDING OWNER INFORMATION (XE APPLICABLE)
NAME:
MAILING ADDRESS: CITY: STATE: Z7P:
PHONE; FAX: CELL:
CONTRACTOR INFORMATION
NAME;VERA WATER&POWER
• MAILING ADDRESS: PO BOX 630 CITY: SPOKANE VALL STATE:WA zIP: 99037
PHONE: (509)924-3800 FAX: (509)922-3929 CELL:
CONTRACTOR LICENSE NO.! EXPIRES! CITY BUSINESS LICENSE NO.:
BOND INSURANCE CERTIFICATE# .er SVMC Title 10 Article 2 :
CONTACT NAME:TODD 1'HARMON PHONE!(509)924-3800
i-t- Ec ED
CSV PERMIT CENTER 1
MAY0 / 2Q5 jii
I Project## gOhe40W -023 '
Name 771 i
1
(Submittal#_____.._____. ____— i
Modified April 14, 2014 Page 1 of 2
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05-06-15;03:40PM; # 2/ 2
**** IF PAVEMENT CUT, C MPLETE THE FQJ.LOWING ****
NATURE OF WORK: Gas Electric Water CATV Communication Sewer Other
(circle one)
TYPE OF CUT/REPAIR: Asphal Gravel Concrete Other
(circle one)
SIZE OF CUTd / r
(width) x (length) !0 PPi �v )( zQ - s-ez. SG 6.)' •.
beri�vL.S
STAFF TO COMPLETE:
ROAD TIER: PAVEMENT CUT POLICY APPLIES?
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 Inures 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) Pians or additional
Information may be required to be submitted and subsequently approved before this application can be processed.
EXPIRATION
Right-of-way permits Issued between April Vt and September 30th are valid for 30 days after the date of Issuance, with a one-time 30-day
extension available. Right-of-way permits Issued between October 1"and March 31"are valid until the following April 30`".
Applicant Signatur Date•5 ,-
Method of payment: ❑ Cash ❑ Check 0 Visa** 0 Mastercard**
** If paying with credit card, the City will call for credit card information when the permit is ready to be issued.
PLEASE FAX TO CITY OF SPOKANE VALLEY (509) 688-0037 UPON COMPLETION
Modified April 14, 2014 Page 2 of 2
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Received Time May. 6. 2015 3: 38PM No, 1845
P. 1
* * * Communication Result Report ( May. 7. 2015 8: 17AM ) * * *
1) Spokane Valley Permit Center
2)
Date/Time : May, 7. 2015 8: 17AM
File Page
No. Mode Destination Pg (s) Result Not Sent
1847 Memory TX 99223929 P. 2 OK
Reason for error
E. 1) Hang up or line fail E. 2) Busy
E. 3) No answer E. 4) No facsimile connect i o n
E. 5) Exceeded max. E—mail size
.
City of Spokane Valley
161cane Community Development
�Y 11707E Sprague Ave..Suite 106
Spokane Valley,WA 99206
(509)720.5240
nermiuwntoresookanevallev oro
ROW-2015-0238 DE-ROW
PROJECT NAME: ISSUED:05!0772016
SITE ADDRESS:15514E 27TH SPOKANE VALLEY EXPIRES:
PROJECT DESCRIPTION:EMERGENCY WATERNAJN REPAIR
PARCEL:
APPLICANT: VERA WATER 8 POWER4NVOICE OWNER: VERA WATER POWER-INVOICE
PO COX 030 VERA DALE,VJA90037 PO BOX630
509-022-3029 VERADALE,WA99037
500.922.3929
OWNER ACTON A5 BUILDER VERA WATER B POWER Omens OWNER
PO NOX 63D Expires:
VERADAI.E,WA90037-0650
FEES: Pu9ld. Dgti
Right of Why $168.00
Totals: 1106.00
CONDITIONS
•Prior to excavation,N is the Contractor responsibility to contact the purveyor of any transmission pipeline that Is within 100
feet of permitted work,as per RCW 19.122.033.
••The traMc Control plan submitted has been applound for Contest only.The Contractor is responsible for determining
apedfic signage and layout es required by the Manual on Uniform Trams Control Devices(MUTCD),WSDOT sped0calbne
and Washington State modification to the MUTCD.All devices shall control lathe MUTCD and WSDOT specifications.
•For all permits that include road obstruction the Contractor shag hairy the Spokane Valley Public Information Officer(PIO)
a 509.720.5411 within 24 hours of receiving this approval.For any changes to the Sdhedide of the road obstruction tine
Contractor shag notify the PIO of the change with a minimum of 48 hour notice prior to the rood o1s0vcEon.The Contractor
that provide the location of the work.expected start and end times ern dates Atha road obstrua:Ien.The PIO will notify the
nrxALpape,school districts,Spokane Valley Pollee Department,or he dispatch as necessary.
•The Cly of Spokane Valley may request changes as warranted by traffic crsrdllions and motorist behavior.
If the construction zone Is open to traffic before completion of Nnel paving the Contractor shag provide warning aigrm,ea
required by Ste MUTCD and WSOOT specifications.
WSDOT Work Zone Traffic Control Guidelines are a a4eble at www_wsda.wegov.For future submittals,please use the
'Work Zone Traffic Control Plans(TC-1—TC-16)f applicable to your prefect_
• For pavement cuts.asdwill drawings(using the current Inland Northwest Regional Pavement Cul Po&.ytemlplate)are
required to be subunt0ed la the Right-ol tfay Inspector,Scott Wallace,vino 15 working days of work being completed.As-
bui0s shall be submitted by email((o svrallace®spokanevalley org),by Fax(500.021-1008)or by dropping off al the Permit
Center.
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