2005, 09-27 Permit App: 05003513 ROW, Plumbing FixturesSep '6 05 09:24a NORMS EXCAVATING
Spokane
.Valley
Call 24 hours bcforC 1spection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
r'•
Anticipated start date 10/4/05 Permit #
Account # 000122
ROW CONSTRUCTION PERMIT
Location of property 816 N. Ravalli Dr.
(Address/Parcel #, if available)
Applicant Name Pringle
Address Same Fax 892-0482
Contractor's Name Norrn's Excavating, Inc.
Address PO Box 574 Veradale, WA 99037 Phone 5091928-0580
Contractor's Reg# NORMSEI972BM Expires 01/14107
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
Driveway
Sewer Connection
Ti Curb & Gutter
F-7 Cable/Conduit/Pole
Other
Pavement Cut
t Gas Installation/Repair
LiSidewalk Repair/Construction
Dimensions
Bond/insurance certification must be on file with the City. Bond #. 103957298
SPECIAL CONDITIONS:
Permittee Signature Approved
Date
hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card # Expiration Oate 09/30105
Name of Holder Sheila Gibbons Signature
Fees Paid$ 70.00
(Application) (Inspection)
In addition to the permit application fee of 816.00 (utility) or 525.00 (construction), inspection on
each permit will be billed to the permittee at a rate of 850.00 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
Date
!nit
Permit not valid until One -Call Notification Ticket # entered here
PERMIT MUST BE KEPT ON SITE
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