2004, 12-08 Permit App: 04009417 ROW Call 24 hours before inspection required /-
Phone 509?688-015 Fax 509.688-0037 /_( . 7,0
Siiokane
.000Valley DEPARTMENT OF PUBLIC WORKS Dec.8,2004
Anticipated start date 12/9/04 Permit# Account# 000122
ROW CONSTRUCTION PERMIT
Location of property 1323 N.Sunderland
(Address/Parcel#,if available)
Applicant Name Codd
Address Same Fax 892-0482
Contractor's Name Norm's Excavating, Inc.
Address PO Box 574 Veradale,WA 99037 Phone 509/928-0580
Contractor's Reg# NORMSEI972BM Expires 01/14/05
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
Sewer Connection E] Driveway
n Curb & Gutter Gas Installation/Repair
Cable/Conduit/Pole ri Sidewalk Repair/Construction
n Other
Pavement 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