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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 V�ey�� NUMBER: o d• O Fax: (509) 688-0037 fi_1� � c) Lu P PE EE. ' ' _, permitcenterOsooka n evallev.ora 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