2005, 03-14 Permit App: 05000909 ROW, Pumbing ReversalMar 14 05 10:03a Sheila Gibbons
*lanen
,,Valley
5098920432
Call 24 hours before inspection required
Phone 509..6688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
p.10
Anticipated start date 3/30/05 Permit #
ROW CONSTRUCTION PERMIT
Location of property 13316 E. Cataldo
(Address(Parcel It, if available)
Applicant Name Gehrman
Account # 000122
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# NORMSE1972BM Expires 01114107
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
x I Sewer Connection
ri Curb & Gutter
Cable/Conduit/Pole
ri Other
Pavement Cut
nDriveway
❑ Gas Installation/Repair
ri Sidewalk Repair/Construction
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
Init
(Application) (Inspection)
In addition to the permit application fee of $16,00 (utility) or $25.OD (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 10:13
5098920432 PRGE.10