2003, 06-19 Permit App: 03003781 SewerL0' 39dd Z£b0 MG 60S
• FAX TO: 892-0432
Job Date: (Rif q( PERMIT # PW r)'3 32 �
City of
SPOKANE VALLEY
UTILITY RIGHT — OF — WAY APPLICATION
AND PERMIT
PUBLIC WORKS DEPARTMENT
APPLICATION -c-Al
Location of property involved (or address) 1
0E :T Cb NI Il
Name of company Norm's Excavating, Inc.
Address of company P.Q. Box 574. Veradale, WA 99037 phone 928-0580
Contractors name Norman Gibbons
Contractors address Same
phone Same
Contractors registration Number NORMSE1972BM Expiration date 01/14/05
Right of Way:
Pavement or sidewalk intrusive. Yes No
Intrusive outside of pavement or sidewalks. Yes No
Length of cut ft. Depth of cut ft. Width of cut ft.
Direction of cut
Contact person Norm or Sheila Gibbons
Address of contact P.O. Box 574, Veradale, WA 99037 Phone 928-0580
i
Please explain in detail the description of the activity proposed. Sewer Hook-up;
Shoulder work with minor encroachment.
I hereby authorize the City of Spokaj a Valley to charge the fee for this permit to my credit card:
w Expire
Visa Mastercharg4
p
Prtnt name of holder Sh _.R` . bons
Signa
(pi
PERMIT: Special Conditions
Restoration:
Permanent
Type of back fill to be used: gravel
Temporary
crushed CDF
This document originally contained
cnnfiden+ial rrodi+ rard infnrmatinn which
was redacted pursuant to RCW 19.255.010
and the original dorun,ont eloctrnyed
pursuant to SOS DAN GS2014-030.
IS A COPY OF A BOND DEPOSITED WITH THE CITY OF SPOKANE VALLEY ? Yes
A COPY OF THE CITY / UTILITY LIABILITY INSURANCE POLICY MUST BE ON
FILE AT THE CITY.
PERMIT FEE S /D. OC)
• Approved
1'I
INSPECTION FEE $
Public Works Director
R-0- WAPP.
Date
CALL 24 HOURS BEFORE INSPECTION NEEDED
Phone 509-688-0036 Fax 509-688-0037
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