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2005, 06-13 Permit App: 05002010 ROW
Call hours boccie mspoctianxegllimd Phone 509.688-0036 Fax 509688-0037 1 DEPARTMENT OF PUBLIC WORKS Anticipated start date Permit # PW (25 ` :21C (l ROW CONSTRUCTION PERMIT Location of property! 0(e Ul\6-- (Address/Parcel #, If available) Applicant Name _).nt Address t tl; Phone 9 3019 Contractor's Name H S Cox Si- If L4-d'L•O 1 1 • Addis /1 g ! 7 If VaIky a Phoria 94A-- ? 4g/ Contractor's R69# PRQ,IECl' DESCRIPTION (Provide site sketch or plan as necessary for clarity) © Sewer Connection ri Club & Gutter SCRIPTION (Prit Other riflGaskon nSidewalk Repair/Construction Bendtinsurarloe certification must be on nide with the . Boni # SPECIAI. CONDITIONS: Permittee Signature Approved I hereby authorize be City of Spokane Yelleyb drama be fee forms perm b my audit card. Card 1_Expketion Dal, Name of Heider S�tsstune Fees Pald$ (Application) (Inspection) In addition to the permit application fee of $18.00 or $25.00, Inspection on each permit will be billed to the permittee ata rata of $5Q.00 per hour with a $25.00 (1/2 hour) minimum. Permittees signature on permit constitutes an agreement to these terms and provisions. Work completed satisfactorily (Signed) Date Date tnit .. •. . •'i...,, 4-1.111% Infiff...atinn Tinier entered hare