2013, 07-08 Permit App: ROW-2013-0341 ROW Jul 0813 06:54a Norm's Excavating, Inc 509-448-4906 10.3
Community Development Department
Permit Center. — "' + (Staff Use Only)
11703 East Sprague Ave i 4 B-3
SaTYpDF kane Spokane Valley, WA 99206
Tel: (509) 688-0036 RMIT
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RIGHT OF WAY (ROW) PERMIT APPLICATION
El DRIVEWAY El PAVEMENT CUT (SEE BELOW) 0 SIDEWALK
0 CURB & GUTTER OTHER
ROAD OBSTRUCTION ® NO ® YES ***TRAFFIC PLAN REQUIRED
PROJECT ADDRESS:18505 E 4TH MINOR ENCROCHMENT ON SHOULDER
START DATE:07/17/13 ANTICIPATED COMPLETION DATE:07/1713
BUILDING OWNER NAME:TABBERT
NAME:TABBERT
ADD RESS:SAME
CITY:SPOKANE VALLEY STATE:WA ZIP:
PHONE: Fax: CELL:
CONTACT NAME:TINA LINGO
PHoNE:5099280580 FAx:448-4906 CELL:
CONTRACTOR NAME:NORMS EXCAVATING INC
MAILING ADDRESS:PO BOX 30873
CITY:SPOKAN E STATE:WA ZIP:99223
PHONE:5099280580 FAx:448-4906 CELL:
CONTRACTOR LICENSE No.:NORMSEI972BM EXPIRES:2/15 CITY BUSINESS LICENSE NO.:
TIER:
POLICY:
BOND/INSURANCE CERTIFICATE #:
(PER SVMCTIT'CE tO ARTI LE 2)
SIGNATURE: ✓� I DATE: 1-/—g—I3
****MUST BE COMPLETE IF PAVEMENT CUT****
TYPE OF WORK CONDITION OF CUT TYPE OF EXISTING ROAD CONDITION
REPAIR
Gas Sawcut Asphalt Depth of Asphalt:
Electric Grind Concrete Depth of Gravel:
(preapproved only)
_Water
CATV
Comm.
Sewer
Other
Effective October 28,2007 Page 1 of 2
C:\Users\Owner\DesIctopWALLEYROW2013.doc