2005, 03-04 Permit App: 05000677 ROW, Plumbing Fixtures, ReversalEXTRA PAGE. 001
Permit not valid until One -Call Notification Ticket #t entered here
PERMIT MUST BE KEPT ON SITE
DEPARTMENT OF PUBLIC WORKS 3/3/05
Anticipated start date 3/17/05 Permit # Account # 000122
ROW CONSTRUCTION PERMIT
Location of property 1208 N. Burns
Applicant Name Jones
(Address/Parcel Si, 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 01114/07
PaOJECT' DESCRIPTION (Provide site sketch or plan as necessary for clarity)
O Driveway
LJ Gas Installation/Repair
▪ Sidewalk Repair/Construction
x Sewer Connection
01 Curb & Gutter
Cable/Conduit/Pole
n Other
nPavement Cut
Dimensions
Bond/insurance 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 _Signature
Fees Paid$ 16.00
$26.00
Date
Inst
(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)
Date