2005, 03-23 Permit App: 05000916 ROW, Plumbing ReversalMar. 23 05 04:41p NORMS EXCAVATING
Sp''rn o nne
,Lily+
N/alley
5098920432
Call 24 hour» before inspection required
Phone 309.68h-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
p.4
Anticipated start date 4/11105 Permit#
ROW CONSTRUCTION PERMIT
Location of property 13222 E. Boone
(Address/Parcel #, if available)
Applicant Name Harrison
Account # 000122
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 01114107
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
x l Sewer Connection Driveway
Curb & Gutter Gas Installation/Repair
n Cable/Conduit/Pole 111 Sidewalk Repair/Construction
Other
Pavement Cut
Dimensions
Bondfinsurance certification must be on file with the City. Bond # 103957298
SPECIAL CONDITIONS:
Permittee Signature Approved Date
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card # Expiration Date 09/30/05
Name of Holder Sheila Gibbons Si. nature
Fees Paid$ 16.00 $25.00
Date
'nit
(Application) (Inspection)
In addition to the pen'nit 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)
Permit not valid until One -Call Notification Ticket # entered here
MAR 23 2005 16:50
Date
PERMIT MUST BE KEPT ON SITE
5098920432 PAGE.04