2005, 07-22 Permit App: 05002517 ROW, Plumbing FixturesFROM : NORM'S EXCAUATING
FAX NU. : ue.iJG
Call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
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DEPARTMENT OF PUBLIC WORKS
Anticipated start date Aug 2, 2005 Permit # Account # 000122
ROW CONSTRUCTION PERMIT
Location of property 14610 E. Nixon
(Address/Parcel #, if available)
Applicant Name Mounts
Address Same Fax 892-0482
Contractor's Name Norm's Exc vatinp, 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)
n.(1 I Sewer Connection D Driveway
Curb & Gutter Gas Installation/Repair
Q Cable/Conduit/Pole El Sidewalk Repair/Construction
El Other
nPavement Cut Dimensions
Bond/insurance certification must be on file with the City. Bond # 103957298
SPECIAL CONDITIONS:
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& 70.00
Date Init
(Application) (Inspection)
In addition to the permit application fee of $16.00 (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. Permittee signature constitutes en 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
JUL 22 2005 10:4?
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