2003, 05-30 Permit App: 03003778 Sewer60'39dd
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FAX TO: 892-0432
Job Date: (o/►4'03
City of PERMIT # PW
SPOKANE VALLEY
UTILITY RIGHT — OF — WAY APPLICATION
AND PERMIT
PUBLIC WORKS DEPARTMENT
APPLICATION
Location of property involved (or address)
Name of company Norm's Excavating, Inc.
Address of company P.O. Box 574, Veradale, WA 99037 phone 928-0580
Contractors name Norman Gibbons
Contractors address Same
phone Same
Contractors registration Number NORMSEI972BM Expiration date 01/14/05
Right of Way:
Pavement or sidewalk intrusive. Yes No
Intrusive outside of pavement or sidewalks. Yes No
Length of cut ft. Depth of cut ft. Width of cut ft.
Direction of cut
Contact person Nsgm or Sheila Gibbons
Address of contact P.O. Box 574, Veradale, WA 99037 Phone .128-0580
Please explain in detail the description of the activity proposed. Sewer Hook-up.
Shoulder work with minor encroachment.
hereby authorize the City of SpEaneeValle to charge the fee for this permit to my credit card:
Visa Masterchar% _ ,,: Expir
Print name of holder Sheila Gibbon` Signat
4 0 3
PERMIT:
Special Conditions
This document originally contained
confidential credit card information which
was redacted pursuant to RCW 19.255.010
and the original document destroyed
pursuant to SOS DAN GS2014-030.
Restoration:
Type of back fill to be used:
Permanent
gravel
Temporary
crushed CDF
IS A COPY OF A BOND DEPOSITED WITH THE CITY OF SPOKANE VALLEY ? Yes
A COPY OF THE CITY / UTILITY LIABILITY INSURANCE POLICY MUST BE ON
FILE AT THE CITY.
PERMIT FEE S /D. c)
• Approved
INSPECTION FEE S
Public Works Director Date
CALL 24 HOURS BEFORE INSPECTION NEEDED
Phone 509-688-0036 Fax 509-688-0037
R — 0 - W APP.
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