2005, 09-27 Permit App: 05003514 ROW, Plumbing FixturesSep 26 05 09:25a NORMS EAU/WA I IrJU
1
Spokane
,'Valley
- Call 24 hbvfs before inspection required
Phone 509.688-0195 Fax 509.Q8-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date 1013/05 Permit#
ROW CONSTRUCTION PERMIT
Location of property 812 N. Ravalli Dr.
(Address/Parcel #, if available)
Applicant Name Coutts
Address Same Fax 892-0482
Account # 000122
Contractor's Name Norm's Excavating, Inc.
Address PO Box 574 Veradale, WA 99037 Phone 509/928-0580
Contractor's Reg# NORMSEI972BM Expires 01/14107
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
nDriveway
nGas Installation/Repair
USidewalk Repair/Construction
7 Sewer Connection
Curb & Gutter
Cable/Conduit/Pole
n Other
Pavement Cut
Dimensions
Bond/insurance certification must be on file with the City. Bond # 103957298
Permittee Signature Approved
Date
1 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
(Application)
(Inspection)
Date
[nit
In addition to the permit application fee of $16.00 (utility) or $25.00 (construction). inspection an
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
SEP 26 2005 09:41
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