2005, 12-01 Permit App: 05004571 ROWCall 141.onrs before nsp cum. regei d _
Thonc9(9.d38-:1195 Fav509.6"-0037, -10
Spokane'' L- —
4"y DEPARTMENT OF PUBLIC WORKS
Anticipated start date A9 7 Permit # Account # 000122
ROW CONSTRUCTION PERMIT
I_o::.rtion of prnlpcay
(Address/Parcel it, if available)
Applicant Name 17 ER e A) -z,--
Contractor's Contractor's
Address PO Box 574 Veradale WA 99037 Phone 50919213-0580
Contractor's Regp NORMSEI972BM
Expires 01/14/07
PROJECT DESCRIPTION (Provide site
sketch or plan as necessary for clarity)
7l Sewer Connection.
Driveway
Curb & Gutter
Gas Installation/Repair
Cable/ConduiVPole
Sidewalk Repair/Construction
Other_
Pavemert Cut
Dimersions
Bond
Permittee Signature Approved Date
hereby au[hor¢e the ,.:ry of Spokane Valley io charge the fee lorthls oermrt to my credit card
Caro 9 Expiration Date 09/3DM5
None of Holder Sheila Gibbons S'o atnre
Fees Paid$ 16.00 $25.00 Date Init
(Application) (Inspection)
In addition to lie Permit sea:icatlon fee of 315.00 (unty) or $2500 (construcbri inspection on
each permit will be belled to the permittee at a rate of $50.00 per hour with a 525 00 (1/2 hri
mir lmcm. Permittee signature const vles an agreement to these terms and Drovisions.
Work completed satisfactorily (Signed)
Permit not valid until One -Call Notification Ticket entered here
PERMIT MUST BE KEPT ON SITE
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