2005, 04-25 Permit App: 05001543 ROWApr 25 05 11:29a
NORMS EXCAVATING
5098920432
p.15
Call 24 hours before inspection required �, l
Phone 5179.688 -0195 Fax 509.688 -0037 "\
�pO�Ile C�,
Salle
y DEPARTMENT OF PUBLIC WORKS
Anticipated start date 5117105 Permit #
ROW CONSTRUCTION PERMIT
Account # 000122
Location of property 12912 & Alki
(Address /Parcel #, if available)
Applicant Name Strawn
Address Same Fax 892 -0482
Contractor's Name Norm's Excavating Inc.
Address TO Box 574 Veradale, WA 99037 Phone 50+91928 -0580
Contractor's Reg# NORMSE1972BM Expires 01/14/07
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
51 Sewer Connection 1:1 Driveway
0 Curb & Gutter EJ Gas InstallationiRepair
Fi CaMe/ConduitlPole F] Sidewalk RepaidConstruction
0 Other
71 Pavement Cut Dimensions
Bondfinsurance certification must be on file with the City. Bond * 103957298
FSPECIALONDITIONS:
Permittee Signature Approved
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card # Expiration Date 0960!05
Name of Holder Sheila Gibbons Signature
Fees Paid$ 16.00 $25.00 Date Init_
(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 (112 hour)
minimum. Perimittee 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
Date
APR 25 2005 11:39 5098920432 PAGE.15