2005, 04-27 Permit App: 05001532 ROWApr 11 05 12:07p NORMS EXCAVATING
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5098920432
Call 2411ou s.before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
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Anticipated start date 4/27/05 Permit #
ROW CONSTRUCTION PERMIT
Location of property 12906 E. Cataldo
(Address/Parcel #, if available)
Applicant Name Evans
Address
Account# 000122
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)
nDriveway
El Gas Installation/Repair
Cable/Conduit/PoIe Sidewalk Repair/Construction
x
Sewer Connection
n Curb & Gutter
J
7-1 Other
Pavement 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
Narne 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 (12 hour)
minimum. Permittee signature constitutes an agreement to these terms and provisions.
Work completed satisfactorily (Signed)
Permit out valid until One -Call Notification Ticket # entered here
PPR 11 2005 12:18
Date
PERMIT MUST BE KEPT ON STTE
5098920432 PAGE.10