2014, 10-13 Permit App: ROW-2014-0576 ROW n4-10-13 14:51 Inland Power Ops 5096264229 >> 5096880037 P 1/2
Community Develot hent Department
Permit Center (Staff Use Only)
SCfrF 11703 East Sprague Avenue, Suite B-3
pokane Spokane Valley,WA 99206 PERMIT NUMBER:
Valley' per
Tel: (509) 720-5240
Fax: (509)itcenterC�688-0037 sookanevallev,orq PERMIT FEE:
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Project ���o����-0A--
RIGHT
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RIGHT OF WAY (ROW) PERMIT A tRPLICAft L V E D
IK DRIVEWAY D PAVEMENT CUT (SEE BELOW) I J SIDEW SLK
CURB &GUTTER 0 OTHER i L.,Tie-1.
2014
ROAD OBSTRUCTION 0 NO 0 YES * *TRA Et IP N REQUIRED
�NMIT CENTER
PROJECT ADDRESS: Ii 17,23 E 3 ! AJe� ! sUs
START DATE: H/3 I ANTICIPATED COM •N . il fB f lg`----
BUILDING OWNER NAME:
NAME: Xris (r Pan nil ( cmcW
. O7t.Y..I iWo 4Oi 'i O
ADDRESS: I ll z 3 r'= 33rd Ioc4IG Iinx.re,paiv wor-LJ
CITY: SPOkl .. \/cUlQ STATE: WA ZIP:
q-
PHONE: 5bl aa.-1 7O Li / FAX: CELL:
CONTACT NAME:
PHONE: FAX: CELL:
CONTRACTOR NAME: -V-j f)fd, Portlier L(51(1-F
MAILING ADDRESS: ' 0 ii D w �aJ l E✓I l 'J
CITY: apo ka.y , STATE: WA ZIP: qq a aL)
PHONE: 5N--7`tet 1,11.S I FAX:51)g--75gg-Lia,aq CEL :
CONTRACTOR LICENSE No.: EXPIRES: C BUSINESS LICENSE NO.:
TIER:
POLICY:
BOND/INSURANCE CERTIFICATE #:
(PER SVMC T E 10
ARTIC2)
SIGNATURE: j/yVvt1L ad / maJIs
;s/b7DA E: /o /3
)cf
.f
****MUST BE COMPLETE IF PAVEMENT CUT****
1
TYPE OF ORK CONDITION OF CUT TYPE OF XISTING ROAD CONDITION
REPAIR
Gas Sawcut Asphalt D th of Asphalt:
Electric Grind Concrete D pth of Gravel:
(preapproved only)
Water _
CATV
Comm. I
Sewer l
Other
{
Effective October 2 , 2007 Page 1 of 2
C:\Users\hmorris\Desktop\Right of Way(ROW) Permit App.doc
Received Time Oct. 13. 2014 1 : 50PM No. 1113
2014-10-13 14:51 Inland Power Ops 5096264229 >> 5096880037 P 2/2
Asphalt(wi.th X length) Concrete(width'X length) Locate Ticket #:
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 onstruction or on a dwelling,the dwelling is/will
be served by potable ater. 2) Ownership of this City of Spokane Valley permit inure to the p perty owner. 3) The signatory is the property
owner or has permissi�'n to represent the property owner in this transaction. 4) All constructio is to be done in full compliance wit the City of
Spokane Valley Devel.pment code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) 1-rhe City of
Spokane Valley permi. is not a permit or approval for any violation of federal,state or local la s, codes or ordinances. 6) Plans or additional
information may be re.uired to be submitted and subsequently approved before this application an be processed.
Signature Date:
PLEASE.FAX TO CITY OF SPOKANE VALLEY (509) 1-0037 UPON COMPLETION
� 68 QLETION
• ' � 7
a I
}
Effective October 2g, 2007 Page 2 of 2
C:\Users\hmorris\Desktop\Right of Way (ROW) Permit App.doc
Received Time Oct, 13, 2014 1 : 50PM No. 1113