2005, 05-11 Permit App: 05001535 Plumbing Fixtures, ROWt70 ' 3Jdd ZEt70Z68605
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Call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
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DEPARTMENT OF PUBLIC WORKS
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Anticipated start date Au/ �i, Od Permit # Account # 000122
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ROW CONSTRUCTION PERMIT
Location of property 3 0 l 1P VV PA- i IL-
(Addre s/Parcel #, if available)
Applicant Name t O 1.6 RTD
Address Same Fax 892-0482
Contractor's Name Norm's Excavating, Inc.
Address PO Box 574 Veradale, WA 99037 Phone 5091928-0580
Contractor's Reg# NORMSEI972BM Expires 01114107
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
ElDriveway
ElGas Installation/Repair
Sidewalk Repair/Construction
x
Sewer Connection
n Curb & Gutter
Cable/Conduit/Pole
Other
Pavement 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 # Expiration Date 09/30/05
Name of Holder Sheila Gibbons Signature
Fees Paid$ 96.00 $25.00
(Application) (Inspection)
Date
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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 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
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