2005, 03-14 Permit App: 05000908 ROW, Plumbing Reversals, FixturesMar 14 05 10:04a
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Sheila Gibbons
Srm rr�
kane
gooValley
5098920432
Call 24 hours before inspection required
Phone 5G- .D88-bi95 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
p.13
Anticipated start date 3/29/05 Permit # Account # 000122
ROW CONSTRUCTION PERMIT
Location of property 13309 E. Cataldo
(Address/Parcel it, if available)
Applicant Name Clemens
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)
( Xi Sewer Connection n Driveway
Curb & Gutter n Gas Installation/Repair
n Cable/Conduit/Pole n Sidewalk Repair/Construction
In Other
nPavement 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
Date
Mit
(Application) (Inspection)
In addition to the permit application fee of $16.00 (utility) or $25.0D (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 4 entered here
PERMIT MUST BE KEPT ON SITE
MAR 14 2005 10:14
5098920432 PRGE.13i