2005, 11-01 Permit App: 05004117 ROWOci ' S U5 111,5p
5neiia Gibbons
s�I's
jValley
5098920432
Call 24 hours before inspection required
Phone 54,1;,.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
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133-0U
Anticipated start date 11/09/05
Permit #
ROW CONSTRUCTION PERMIT
Location of property 4809 E. 3rd
Applicant Name Pokorny
Address Same
Account # 000122
(Address/Parcel #, if available)
Contractor's Name Norm's Excavating, 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
71 l Sewer Connection
Curb & Gutter
Cable/Conduit/Pole
Other
site sketch or plan as necessary for clarity)
nDriveway
nGas Installation/Repair
nSidewalk Repair/Construction
Pavement Cut
Dimensions
Bond/insurance certification must be on fie 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
Warne of Holder Sheila Gibbons Signature
Fees Paid$ 70.00
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
OCT 31 2005 12:30
5098920432 PAGE.03