2005, 05-11 Permit App: 05001540 Plumbing Reversal, ROWApr 25 05 11:28a
NORMS EXCAVAIINV
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Call 24 -hours Yore inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date 5/10105 Permit # Account* 000122
ROW CONSTRUCTION PERMIT
Location of property 819 N.:. J T
(Address/Parcel #, if available)
Applicant Name Ward
Address
Same
Contractor's Name Norm's Excavatinct, Inc.
Fax 892-0482
Address PO Box 574 Veradale, WA 99037 Phone 509/928-0580
Contractor's Reg# NORMSEI972BM Expires 01/14/07
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
I x I Sewer Connection El Driveway
F-1 Curb & Gutter Gas Installation/Repair
El Cable/Conduit/Pole Ei Sidewalk Repair/Construction
n Other
nPavement 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$ 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 cgtnpleted satisfactorily (Signed)
Date
Permit not valid until One -Call Notification Ticket # entered here
PERMIT MUST BE KEPT ON SITE
APR 25 2005 11:38
5098920432 PAGE.89