2005, 03-25 Permit App: 05000917 ROW, Plumbing ReversalMar 23 05 04:42p NORMS EXCAVATING
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5098920432
Cali 24 hours before inspection required
Phone 509..6j8-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
p.7
CC -IT 7
Anticipated start date 4/12105 Permit #
ROW CONSTRUCTION PERMIT
Location of property 13216 E. Boone
Applicant Name Englehardt
Account # 000122
(Address/Parcel #, if available)
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)
xn Sewer Connection C Driveway
Curb & Gutter Ei Gas Installation/Repair
Sidewalk Repair/Construction
n Cable/Conduit/Pole
n Other
1-1 Pavement Cut
Dimensions
Bondfinsurance certification must be on Tile with the City_ Bond # 103957298
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 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 (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;51
Date
PERMIT MUST BE KEPT ON SITE
5098920432 PAGE,07