2005, 06-13 Permit App: 05002047 ROW, Plumbing Reversal, FixturesS0'3OUd z2D0z68605
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Call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date June 22,2005 Permit # Account # 000122
ROW CONSTRUCTION PERMIT
Location of property 13006 E. Cataldo
Applicant Name Kalserman
(Address/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 01/14/07
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
• Driveway
• Gas Installation/Repair
• Sidewalk Repair/Construction
x
Sewer Connection
Curb & Gutter
n Cable/Conduit/Pole
Other
DPavement Cut
Dimensions
Bondfinsurance ceniflcation 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 09730)05
Name of Holder Sheila Gibbons Signature
Fees Paid$ 16.00 $25.00
Date
Unit
(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
Permit not valid until One -Call Notification Ticket # entered here
PERMIT MUST BE KEPT ON SITE
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