2005, 09-28 Permit App 05003537 ROW for Gas Service Call 24 hours before inspection required p
Phone 509.688-0195 Fax 509.688-0037 -v
Spokane
40,Valley DEPARTMENT PUBLIC OF WORKS O RK S
Anticipated start date 9/28/05 Permit # Account #
ROW CONSTRUCTION PERMIT
LOCATION OF PROPERTY- 3220 N Coleman
(Address/Parcel#, if available)
Applicant Name Avista Utilities Fax 534-2463
Address 1411 E. Mission Ave. Spokane,Wa. 99202— Ann msc46 Phone 509-495-2244
Customer's Name Keelyn Gordon
Address Phone
Contractor's Reg.# Expires
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
Sewer Connection Driveway
Curb & Gutter x Gas Installation/Repair
Cable/Conduit/Pole Sidewalk Repair/Construction
Water Installation/Repair n Other
Pavement Cut Dimensions
Bond/insurance certification must be on file with the City. Bond#
ISPECIAL INSTRUCTIONS): Install 70 ft from stub at NW property corner I
Job# 442166831 Loc# 5323246
Permittee Signature_AKC Approved Date
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card# Expiration Date
Name of Holder Signature
Fees Paid$ 25.00 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 billed to the permittee 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.
Work completed satisfactorily(Signed) Date
Permit not valid until One-Call Notification Ticket#entered here
PERMIT MUST BE KEPT ON SITE