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