2004, 03-23 Permit App 04-00156 ApproachSikokane~
Va11ey
Ca11 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date
Permit # 04-156 Account #
ROW CONSTRUCTION PERMIT
Location of property 2324 N. Wilbur Rd.
(Address/Parcel #, if available)
Applicant Name Victor Grant Fax 509-922-5518
Address 18120 E. Boone, Spokane Valley, Wa. 99016 Phone 509-218-4876
Contractor's Name
Address
Phone
Contractor's Reg.# Expires
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
❑ Sewer Connection ■
Curb & Gutter
Cable/Conduit/Pole
❑ Water Installation/Repair
nPavement Cut
Driveway
Gas Installation/Repair
Sidewalk Repair/Construction
Other
Dimensions
Bond/insurance certification must be on file with the City. Bond #
SPECIAL CONDITIONS: Construct driveway approach per Spokane County Standards as
adopted by the City of Spokane Valley.
See attached Provisions
Permittee Signature Approved -Dated �,3
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 25.00 Date 3-23-2004 Init K.C.
(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