2003, 05-29 Permit App: PW03-209 ROW 20 30d Z2b0 Z68 60S 617:ZT £00Z TT AdW
-- FAX TO: 892-0432 �.
City of Job Date: aq c PERMIT # PW o 3-205'
SPOKANE VALLEY
UTILITY RIGHT-OF - WAY APPLICATION
AND PERMIT
PUBLIC WORKS DEPARTMENT
APPLICATION
Location of property involved (or address) `/5-0 3 C • ./7n
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 Norm or Sheila Gibbons
Address of contact P.O.Box 574, Veradale,WA 99037 Phone 928-0580
Please explain in detail the description of the activity proposed._ Sewer Hook-up,
Shoulder work with minor encroachment.
I hereby authorize the City of Spo alley to charge the fee for this permit to my credit card:
Visa Mastercharge .. �` ___ ____ spire
Cmoi' �'jf2/�i!�'�y�
Print name of holder Sh Gibbons Signatuf
PERMIT: Special Conditions
i his document originally contained
confidential credit card information which
..a] red-Alen pursuant to RCW 19.255.010
and the original document destroyed
Restoration: Permanent Temporary p""uani to sos DAN G52014-030.
Type of back fill to be used: gravel 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 $ /Do OCA INSPECTION FEE$
Approved
Public Works Director Date
CALL 24 HOURS BEFORE INSPECTION NEEDED
Phone 509-688-0036 Fax 509-688-0037
R—O- W APP.
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