2005, 05-11 Permit App: 05001539 Plumbing Reversal, ROWApr 25 05 11:27a NORMS EXC;AVA I INCA
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*lane
Call 24 hours before inspection required
P 'ie 509688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date 519/05 Permit #
ROW CONSTRUCTION PERMIT
Location of property 913 N. Ravaili Ct
(Address/Parcel #, if available)
Applicant Name Benshoof
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 01114/07
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
I X I Sewer Connection n Driveway
TiCurb & Gutter Gas Installation/Repair
Cable/Conduit/Pole Sidewalk Repair/Construction
[] 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$ 16.00
$25.00
Date
!nit
(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 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
APR 25 2005 11:37
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