2005, 03-25 Permit App: 05000910 ROW, Plumbing ReversalMar 14 05 10:03a Sheila Gibbons
Siblane
00Valley
5098920432
Call 24 hours before inspection required
Phone 569.6880195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
p.7
SIO
Anticipated start date 3128/05 Permit #
ROW CONSTRUCTION PERMIT
Account# 000122
Location of property 12824 E. Cataldo
(AddresslParcel #, if available)
Applicant Name Faraca
Address Same Fax 892-0482
Contractor's Name Norm's Excavating, Inc.
Address PO Box 574 Veradale, WA 99037 Phone 5091928-0580
Contractor's Reg# NORMSEI972BM Expires 01/14/07
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
XSewer Connection n Driveway
Curb & Gutter El Gas Installation/Repair
Cable/Conduit/Pole [1 Sidewalk Repair/Construction
ri Other
riPavement Cut
Dimensions
Bond/insurance certification must be on file 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
(Application) (Inspection)
Date
Init
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
Permit not valid until One -Call Notification Ticket # entered here
PERMIT MUST BE KEPT ON SITE
MAR 14 2005 10:12
5098920432 PRGE.07