2005, 03-03 ROWFROM : NORM'S EXCAVATING
spbrkane
dosigValley
FAX NO. : 509 892 0432
Mar. 03 2005 12:04PM P14
Ci;A 24 hours before inspection required
Phonc509.588-0195 Fax 509,688-0037
n
DEPARTMENT OF PUBLIC WORKS 3/3/05
Anticipated start date 3/14105 Permit # Account # 000122
Location of property
Applicant Name
Address
Wilson
ROW CONSTRUCTION PERMIT
15223 E. Cataldo
(Address/Parcel #, if available)
24c-14 I ,1)4)9 -
Wilson b4►Q-
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)
x Sewer Connection ❑ Driveway
❑ Gas Installation/Repair
❑ Sidewalk Repair/Construction
Curb & Gutter
n Cable/ConduitlPole
❑ 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 It 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 516.00 (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. Perrnittee 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 03 2005 12:13
509 892 0432 PRGE.14