2005, 12-21 Permit App 05004727 ROW••#%,„
*lane
Ca11 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
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Anticipated start date 12/23/05 Permit # Account #
ROW CONSTRUCTION PERMIT
LOCATION OF PROPERTY- N 1215 Flora
Applicant Name
(Address/Parcel #, if available)
Avista Utilities Fax 534-2463
Address 1411 E. Mission Ave. Spokane, Wa. 99202 — Ann msc46 Phone 509-495-2244
Customer's Name Robert Abbott
Address Phone
Contractor's Reg.# Expires
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
7 Sewer Connection Driveway
Curb & Gutter x Gas Installation/Repair
n Cable/Conduit/Pole n Sidewalk Repair/Construction
n Water Installation/Repair n Other
nPavement Cut
Dimensions _
Bond/insurance certification must be on file with the City. Bond #
SPECIAL INSTRUCTIONS): INSTALL TEST LEADS ON CASE AND PIPE AND INSTALL FINK AT
SOUTH VENT PIPE 50' SOUTH OF BOONE AND 25 FT WEST CL OF FLORA - Job# 540177535
Permittee SignatureAKC 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 Si.nature
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