2010, 03-24 Permit App 10000798 SewerRECEIVED 03/23/2010 16:19 5096680037
SV PERMIT CENTERFR
Work completed satisfactorily (Signed)
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Permit not valid until One -Call Notification Ticket # entered here and the
PERMIT MUST BE KEPT ON S1t'1'k. P'
SpaRage
sesValley
Cali 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
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Anticipated start date 3/29/10 Permit #
ROW CONSTRUCTION PERMIT
Location of property 11403 E. Broadway
Applicant Name Chapman
{Address/Parcel #, if available)
Account # 000122
Address Same Fax 892-0432
Contractor's Name Norm's Excavating, Inc.
Address PO Box 574 Veradale, WA 99037 Phone 509/923-0530
Contractor's Reg# NORMSEI972BM Expires 01/14/11
PROJECT DESCRIPTION {Provide site sketch or plan as necessary for clarity)
x Sewer Connection ❑ Driveway
M I Curb & Gutter ❑ Gas Installation/Repair
1 Cable/Conduit/Pole n Sidewalk Repair/Construction
j_ 1Other
❑ Pavement Cut Dimensions
Bondfinsurance certification must be on file with the City. Bond # 1039572 98
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
.ard tale_
Expiration Date
Name of Holder Sheila Gibbons Signature
Fees Paid$_ 110.00
Date
!nit
(Application) (Inspection)
In addition to the permit application fee of 816.00 (utility) or $25.00 (construction), inspection on co^rained
each permit will be billed to the permittee at a rate of $50.00 per hour with a $25.00 (1/2 hour ;nativ
minimum. Permittee signature constitutes an agreement to these terms and pro '• -. d°current onB,nformat1On whwh
ed
7hre coedit card 19,255.010
D- econfidenti?YQ8 pursuant t to RO t .255. 10
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