2012, 08-21 Permit App: ROW-2012-0371 ROWSpokane
_Valley
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Call 24 hours efore inspection required
Phone 509.68 -0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
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Anticipated start date August 28, 201 Permit # Account # 000122
ROW CONSTRUCTION PERMIT
Location of property 1508 S Bolivar
(Address/Parcel #, if available)
Applicant Name Gibson
Address Same
Contractor's Name Norm's Excavating, Inc.
Fax 892-0432
Address PO Box 574 Veradale, WA 99037 Phone 509/928-0580
Contractor's Reg# NORMSEI972BM Expires 01114/13
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
EiDriveway
Gas Installation/Repair
ElSidewalk Repair/Construction
I ^ 1
Sewer Connection
Curb & Gutter
El Cable/Conduit/Pole
El Other
nPavement Cut
Dimension
Bond/insurance certification must be on file with the City. Bond # 103957298
SPECIAL CONDITIONS:
Permittee Signature Aplproved Date
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card # See Cover Sheet Expiration Date
Name of Holder Signature
Fees Paid$ 110.00
Date !nit
(Application) (Inspectio )
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 $5 00 per hour with a $25.00 (1/2 hour)
minimum. Permittee signature constitutes an agreement Ito 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
2.c1 2u i a.eneOx1 stuJou e r 2 : Rn 21 12 2n -1