2014, 09-22 Permit App ROW-2014-0514 Poles# 1/ 2
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Spokane
Valley -
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Vahiey, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
Qermitcenter(aspoka nevallev.orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE;
RIGHT OF WAY (ROW) PERMIT APPLICATION
0 APPROACH
0 CURB & GUTTER
PAVEMENT CUT (SEE BELOW)
WORK THROUGH MANHOLE
0 SIDEWALK
D OTHER
ROAD OBSTRUCTION 0 NO K(YES (if yes, complete the following) '
• % of street or # lanes that will be obstructed: ( LA.)
• Length of time street will be obstructed: 1 I-1ook5
1=> If work closes more than 50% of a Ioca1 ac ss street, or closes any portion of an arterial street,
then a TRAFFIC PLAN IS REQUIRED Pre -Approved TCP Proposed: "7 P ,
PROJECT ADDRESS: 109 5
APPLICANT'S JOB #:
START DATE: 1/2,.,/l/cal
PROJECT DESCRIPTI N:
I sT1 L(ruC.
Ac.ccs'
PARCEL NUMBER:
LOCATE TICKET #
ANTICIPATED COMPLETION DATE: /o z%' %jcl
-rd`E5 A -b co / rr
¥RbG
Project #-1_
RECEIVED
PROPERTY OR BUILDING OWNER INFORMATION (IF APPLICABLE)`£P 2 2 2014
NAME:
MAILING ADDRESS: CITY:
PHONE: FAX:
CENTER
STATE: ZIP.
R
CELL: Fr'
CONTRACTOR INFORMATION
NAME: VERA WATER & POWER
MAILING ADDRESS: PO Box 630
PHONE: (509)924-3800
CONTRACTOR LICENSE NO.:
CITY: SPOKANE VALL
FAX: (509)922-3929
EXPIRES: CITY BUSINESS LICENSE NO.:
STATE: WA zip: 99037
CELL:
BOND/INSURANCE CERTIFICATE # (per SVMC Title 10, Article 2);
CONTACT NAME: TODD HARMON
PHONE: (509)924-3800
Modified April 14, 2014
C:\Usecgrharmon.VERAWP\Documents\Spokane Valley ROWPA.doC
Page 1 of 2
Received Time Sep. 22. 2014 12:50PM No.0975
09-22-14;01:05PM;
**** IF PAVEMENT CUT, COMPLETE THE FOLLOWING ****
# 2/ 2
NATURE OF WORK:
(circle one)
Gas
anr
Water
CAN
Communication
Sewer
Other
TYPE OF CUT/REPAIR:
(circle one)
Caapja
Gravel
Concrete
Other
SIZE OF CUT
(width) x (length)
7 k 2_5
STAFF TO COMPLETE:
ROAD TIER: PAVEMENT CUT POLICY APPLIES?
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 Inures 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 Wiley Development code. Referenced codes are available for review at the Clry of Spokane Wiley 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.
,EXPIRATION
Right-of-way permits Issued between April 10 and September 30th are valid for 30 days after the date of Issuance, with a one-time 30-day
extension available. Right-of-way permits issued between October Y` and March 31st are valid until the following April 30`".
Applicant Signattn'e:— --- ce`/ v _� Date:
Method of payment: ❑ Cash ❑ Check ❑ Visa** ❑ Mastercard**
**If paying with credit card, the City will call for credit card information when the permit is ready to be issued.
PLEASE FAX TO CITY OF SPOKANE VALLEY (509) 688-0037 UPON COMPLETION
Modified April 14, 2014 Page 2 of 2
C:\Users\tharmon.VERAWP\Documents\Spokane Valley ROWPA.doc
Received Time Sep. 22. 2014 12:50PM No.0975