2006, 01-11 Permit App 06000100 Right of Way*lane
.Malley
Call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date 0)/0 <p
Permit # Account #
ROW CONSTRUCTION PERMIT
Location of property Just West of Pines along South side of Broadway to the West side of Blake Rd
Applicant Name EMAN Networks
(Address/Parcel #, if available)
Fax (253) 845-9060
Address 3005 30th Ave SE, Puyallup, WA 98374
Contractor's Name Potelco, Inc
Phone (888) 399-0297
Address 13521 East Trent, Spokane, WA 99216
Contractor's Reg.# POTELI*34404
Phone (509) 926-6003
Expires 05/31/2007 Eri c Lv�t✓Y
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
ElSewer Connection n Driveway
Curb & Gutter 111 Gas Installation/Repair
1 Cable/Conduit/Pole n Sidewalk Repair/Construction
EWater Installation/Repair n Other
0 Pavement Cut Dimensions
Bond/insurance certification must be on file with the City. Bond #,
SPECIAL CONDITIONS:
See attached Provisions
Permittee Signature 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)
Permit not valid until One -Call Notification Ticket # entered here
Date
PERMIT MUST BE KEPT ON SITE