Loading...
2015-04-21 Permit App ROW-2015-0199 Comcast CabinetSiftikane Valley. Community Development Department Permit Center 11703 East Sprague Avenue, Suite B-3 Spokane Valley, WA 99206 Tel: (509) 688-0036 Fax: (509) 688-0037 permitcenterC&sookanevalley.ora (Staff Use On)y) PERMIT NUMBER: PERMIT FEE: RIGHT OF WAY (ROW) PERMIT APPLICATION Li APPROACH E-1 PAVEMENT CUT (SEE BELOW) ED SIDEWALK D CURB & GUTTER D WORK THROUGH MANHOLE El OTHER ROAD OBSTRUCTION 0 NO D YES (if yes, complete the following) • % of street or # lanes that will be obstructed: • Length of time street will be obstructed: i=> If work closes more than 500/0 of a local access street, or closes any portion of an arterial street, then a TRAFFIC PLAN IS REQUIRED fl Pre -Approved TCP Proposed: PROJECT ADDRESS: J110 S. Owt Cf- PARCEL NUMBER: y APPLICANT'S JOB #: /02,34/32. LOCATE TICKET # IS! 073Sl4f START DATE: 1./ /2.2J2D1 5 ANTICIPATED COMPLETION DATE: 5-i5,20/5- PROJECT DESCRIPTIO : PI tii—e /0147 Com c Carb,xe -TA•nr Potkvf rob )e4i»cl Sticle wail/ On 5 . p,c Rck he ki/eeil Fetich,' -t 5-tgebvp/4 Worh PROPERTY OR BUILDING OWNER INFORMATION (IF APPLICABLE) NAME: MAILING ADDRESS: CITY: STATE: ZIP: PHONE: FAX CELL: CONTRACTOR INFORMATION NAME: 3 ef.01147-0:5-6-0-A-/Y1t4 fl c a 4.;o ei 5 MAILING ADDRESS: 0) J N. PHONE: 509 53.2 - 611 -}0 e-oinccesf 631c fv CITY: C.)(1i)t" Veillej STATE: FAX: 50'i - _53.2 = 65)5 CONTRACTOR LICENSE NO.: 6o 1V, 1 i EXPIRES: BOND/INSURANCE CERTIFICATE # (per SVMC Title 10, Article 2): CONTACT NAME: t2a2 13rennc4n CELL: tAih ZIP: 9(72)6 CITY BUSINESS LICENSE NO.: PHONE: 020t 7V-5 C/ V L:U CSV PERMIT CENTER APR 2 1 2015 1 Project # q01?-14/57:_• (MI Name 77, Submittal 4- Modified April 14, 2014 htto://www.spokanevalley,org/filestorage/124/938/210/94e/1496/2831/ROWPA.cloC Page 1 of 2 **** IF PAVEMENT CUT, COMPLETE THE FOLLOWING **** NATURE OF WORK: (circle one) TYPE OF CUT/REPAIR: (circle one) SIZE OF CUT (width) x (length) Gas Electr c Asphalt Water Gravel CATV I Communication Concrete Sewer STAFF TO COMPLETE: ROAD TIER: PAVEMENT CUT POLICY APPLIES? Other Other 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 Valley Development code. Referenced codes are available for review at the City of Spokane Valley 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 1" and September 30" 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 1" and March 31" are valid until the following April 30w. Applicant Signature: Date: 120 7/5 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 www.sookanevall lestorage/124/938/210/948 /$831/ROWPA.doc Page 2 of 2