2006, 01-12 Permit App 06000086 Road ObstructionSp�'
jValley
Ca11 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
OCac
9-0
Anticipated start date 01/17/06
Permit # Account #
ROW CONSTRUCTION PERMIT
LOCATION OF PROPERTY- E. 6225 17th Ave
(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
Address Phone
Contractor's Reg.# Expires
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
Sewer Connection Driveway
Curb & Gutter
Cable/Conduit/Pole
Water Installation/Repair
Pavement Cut
Gas Installation/Repair
Sidewalk Repair/Construction
Other
Dimensions
Bond/insurance certification must be on file with the City. Bond #
SPECIAL INSTRUCTIONS): Replacing street light pole
Job #1178212 Loc# 6009036
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