2005, 02-16 Permit App: 05000386 Plumbing Reversal/ROW 7�•VY >VV4r •v ...rr
---- 90'30eld Zzt70 Z68 60S
Call 24 hours before inspection required
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Lj� DEPARTMENT OF PUBLIC WORKS
Anticipated start date //tp/O. Permit# Account# 000122
ROW CONSTRUCTION PERMIT
Location of property %Z 0,5"
(AddresslParcel#,,if available)
Applicant Name 11--e l4 /i� G / c
Address Some- /3 &/ 7 1 7-"e4Fax 892-0482
Contractor's Name Norm's Excavating. Inc.
Address PO Box 574 Veradale,WA 99037 Phone 509/928-0580
Contractor's Reg# NORMSEI972BM Expires 01/14/07
pOJECT DESCRIPTION(Provide site sketch or plan as necessary for clarity)
x Sewer Connection ❑ Driveway
n Curb&Gutter Gas Installation/Repair
I I Cable/Conduit/Pole U Sidewalk Repair/Construction
t i Other
ElPavement Cut Dimensions
Bond/insurance certification must be on file 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
Name of Holder Sheila Gibbons Si•nature •���..
Fees Pald$ 16.00 $25-00 Date Ink
(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
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