2009, 11-20 Permit App 09003731 POD in ROWProject Number: 09003731 Inv: I Application Date: 11/20/2009 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: ROW - PODINROW Contact: RICHARD & JILL FIEDLER
Address: 3941 S EAGLE LN
C - S - Z: SPOKANE VALLEY WA 99206
Setbacks: Front Left: Right: Rear: Phone: (509) 924-1964
Group Name:
Project Name
Site Information:
=::N➢xti s__ �,.s ".Uk's"fit_ .. ...E'er,;* =..:> .."'UC"x
Plat Key: 005619 Name: GREENS AT MIDILOME PUD, THE District: East
Parcel Number: 45331.4903 Block:
SiteAddress: 3941 S EAGLE LN
Location:: CSV
Zoning: R-3 SF Res District
Water District: 007 MODEL
Area: 6,538 Sq Ft Width: 0
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Lot:
Owner: Name: RICHARD & JILL FIEDLER
Address: 3941 S EAGLE LN
SPOKANE VALLEY WA 99206
Hold: ❑
Depth: 0 Right Of Way (ft): 30
Review Information:
Review
Other Reviews
Permits:
Released By:
Right of way
Contractor: OWNER Firm: OWNER .
Phone: (000) 000-0000
Item Description Units Unit Desc Fee Amount
ROW - NO CUT OBS NO CLEAN 1 NUMBER OF $73.00
Permit Total Fees: $73.00
Operator: JD Printed By: JD Print Date: 11/20/2009
Project Number: 09003731 Inv: 1 Application Date: 11/20/2009 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes:
Payment Summar V: �r�-� ..
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Right of Way $73.00 $73.00 $0.00 $73.00
$73.00 $73.00 $0.00 $73.00
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: JD Printed By: JD Print Date: 11/20/2009
Siokane (Staff Use Only)
PERMIT NUMBER: ".� 1Li
Valley
PERMIT FEE:
° V
CITY OF SPOKANE VALLEY
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
RIGHT OF WAY (ROW) PERMIT APPLICATION
❑ DRIVEWAY ❑ PAVEMENT CUT (SEE BELOW) ❑ SIDEWALK
❑ CURB & GUTTER ® OTHER
ROAD OBSTRUCTION ❑ NO ® YES ***TRAFFIC PLAN REQUIRED
PROJECT ADDRESS:3941 S. EAGLE LN SPOKANE VALLEY,WA 99206(THE GREENS AT MIDILOME)
START DATE:12/10/09 ANTICIPATED COMPLETION DATE:12/14/09
BUILDING OWNER NAME:RICHARD AND JILL FIEDLER(PODS IN STREET TO MOVE INTO NEW RESIDENCE)
NAME:RICHARD AND JILL FIEDLER
ADDRESS:3941 S. EAGLE LN
CITY:SPOKANE VALLEY STATE:WA ZIP:99206
PHONE: FAX: cELL:253-332-1214
CONTACT NAME:RICHARD FIEDLER
PHONE: FAX: cELL:253-332-1214
CONTRACTOR NAME:PODS
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE
NO.:
TIER:
POLICY:
BOND/INSURANCE CERTIFICATE #:
(PER SVMC TITLE 10 ARTICLE 2)
SIGNATURE: DATE:
Effective October 28, 2007 Page 1 of 2
Macintosh HD:Users:richardandjill:Downloads:Right of Way (ROW) Permit App.l.doc
I
****MUST BE COMPLETE IF PAVEMENT CUT****
Type of Work Condition of Cut Type of Existing Road Condition
Repair
Gas Sawcut Asphalt Depth of Asphalt:
Electric Grind Concrete Depth of Gravel:
(preapproved only)
Water
CATV
Comm.
Sewer
Other
Asphalt (width X length) Concrete (width X length) Locate Ticket #:
X X X
X 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 construction or on a dwelling,the dwelling Is/will
be served by potable water. 2)Ownership of this City of Spokane Valley permit inure 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) Plans or additional
information may be required to be submitted and subsequently approved before this application can be processed.
i fri,
Signature V-`. ,L.__.4t` s+ 1 � Date: .f jl f e ci.
J
Method of payment: ❑ Cash ❑ Check ❑ Visa Rivlastercard
Bankcard #: `>� , .. f~C — 122. 2. ._f,C)1 EXP: r }i7i2. VIN#: c. [,
Authorized Signature: V,
PLEASE FAX TO CITY OF SPOKANE VALLEY (509) 688-0037 UPON COMPLETION
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Effective October 28, 2007 Page 2 of 2
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