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2004, 12-02 Permit App: 04009275 ROWFROM 1.15 WEST Spn ka e� $U lley (THU) 12. 2'04 11:05/ST. 11: 04/NO. 4862876819 F 2 Call 24 bows before inspection required Phone 509.688-0036 Fax 509.686-0037 DEPARTMENT OF PUBLIC WORKS Anticipated start date /0/0% Permit # PW ROW CONNST�R.U/n�C��TION PERMIT Location of property 94i* Aja 1- ! _t�Rd ��r01'' ir Address/Parcel #, if available) ni Applicant Name,7,N!!;5/' ('r'.1" Address if Al &( Z :hii° Phone �'94 Contractor's Name £G11Yl r Soar/ail" Address 109 E. kZ#bll 0,4 Phone 4(3—lia-3 Contractor's Reg# lekCOUr.,�77 Expires PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity) Sewer Connection Curb 8 Gutter H. Cable/Conduit Other Pavement Cut? Driveway Gas Installation Sidewalk Repair/Construction Dimensions Bond/insurance certification must be on Nle " w�ith the Cihr Bond # SPECT CONDITIONS: 1Vtli✓IrcYK.r/ f»1 `11e. attic?' CIP of Farr. 45)'S°rA of 44YmK JNn nP 2i4act s Firly Permittee Signatureil Approved hereby authonze the City of Spokane Valley to charge the fee (dr this permit to my credit card. Card # Name of Holder Signature Expiration Date Fees Paid$ Date !nit (Application) (Inspection) In addition to the permit application fee of $16.00 (utility) or $25.00 (construction), inspection on each permit will be hilted to the permirtee at a rate of $50.00 per hour with a $25.00 (1/2 hour) minimum. Permittee signature constitutes an agreement to these terms and provisions. Werk completed satisfactorily (Signed) Date Permit not valid until One -Call Notilcadon Ticket # entered here PERMIT MUST BE KEPT ON SITE DEC 02 2004 1049 15094552104 Pf7GE.02