2005, 01-05 Permit App: 05000012 Plumbing Reversal, ROW030d 217e Z66 60S
Slitikane
Call 24 boars before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date 5/6 6-- Permit #
ROW CONSTRUCTION PERMIT
Location of property 116 • BLiPt-51)
TS:ST P00? 02 D3G
Account # 000122
Applicant Name 5 Ai ERPOI)
ikcidress/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 01114/05
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
ESewer Connection Driveway
[] Curb & Gutter El Gas Installation/Repair
—1 Cable/Conduit/Pole ri Sidewalk Repair/Construction
El Other
Pavement Cut
Dimensions
Bond/insurance certification must be on file wfth the City. Bond #JM.5.2/913____
Permittee Signature Approved Date
I hereby authorize the City of Sp ane Valley to charge the fee for this pormit to my credt card.
Card # Expiration Date 09/30/05
Name of Holder Sheila Gibbons Signature
Fees Paid$ 16.00 $25.00 Date !nit
(Application) (Inspection)
In addition to the perrnit application fee of $16.00 (utility) or $25.00 (construction), inspection on
each permit will be billed to the perrnittee 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) Date
Permit not valid until One -Call Notification Ticket # entered here
PERMIT MUST BE KEPT ON SITE
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E2t70 ?68 60S : 'ON XdJ ONI1UnUDX3 S,WeiON : WO6A