2005, 06-30 Permit App: 05002315 ROWFROM : NORM'S EXCAVATING
."Valley Iey
FAX NO. : 509 892 0432
Jun. 30 2005 08:38AM P5
Call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date 7/11105 Permit # Account # 000122
ROW CONSTRUCTION PERMIT
Location of property 11221 E. Boone
(Address/Parcel #, if available)
Applicant Name Kimp
Address Same Fax 892-0482
Contractor's Name Norm's Excavating. Inc.
Address PO Box 574 Veradale, WA 99037 Phone 509/928-0580
Contractor's Reg# NORMSEI972BM Expires 01/14/07
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
Qx Sewer Connection Driveway
nCurb & Gutter 0 Gas Installation/Repair
n Cable/Conduit/Pole 0 Sidewalk Repair/Construction
1-1 Other
nPavement Cut
Dimensions
Bondhnsurance certification must be on file with the City. Bond # 103951218
Permittee Signature Approved
Date
I hereby authorize the City of Spokane Valley to charge the fee for this pemld to my credit card.
Card # Expiration Date 09/30105
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 350.00 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
JUN 30 2005 08:49
509 892 0432 PRGE.05