2005, 09-27 Permit App: 05003512 ROW, Plumbing FixturesSep 26 05 09:24a NORMS EXCAVATING
SO ne
FUalley
Call 24 )tours before.i spection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
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Anticipated start date 10/5/05 Permit # Account # 000122
ROW CONSTRUCTION PERMIT
Location of property 12919 E. Cataldo
(Address/Parcel #, if available)
Applicant Name Peebler
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 01114107
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
x I Sewer Connection ri Driveway
Curb & Gutter
Cable/Conduit/Pole
Other
Pavement Cut
❑ Gas Installation/Repair
Sidewalk Repair/Construction
Dimensions
Bond/insurance certification must be on file with the Cit . Bond # 103957298
SPECIAL CONDITIONS:
Permittee Signature Approved
Date
[ hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card # Expiration Cate 09/30/05
Name of Holder Sheila Gibbons Signature
Fees Paid$ 70.00
(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 525.00 (1/2 hour)
minimum. Permittee signature constitutes an agreement to these terms and provisions.
Date
In it
Work completed satisfactorily (Signed)
Date
Permit not valid until One -Call Notification Ticket # entered here
PERMIT MUST BE KEPT ON SITE
SEP 26 2005 09:40
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