2005, 02-25 Permit App 05000583 Plumb Reversal, ROWZ0.3ald Z240 Z68 60S £T:4T S00Z SZ H3d
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Call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
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Anticipated start date 3/2/6 5 Permit #
ROW CONSTRUCTION PERMIT
Location of property 3 z / 6--- N
(Address/Parcel #, if available)
Applicant Name E R i c K Son J
Address
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Account# 000122
Same Fax 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
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
I x l Sewer Connection ❑ Driveway
Curb & Gutter ❑ Gas Installation/Repair
Cable/Conduit/Pole ❑ Sidewalk Repair/Construction
Other
Pavement Cut Dimensions
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Bond/insurance certification must be on file with the City. Bond # 103957 98
SPECIAL CONDITIONS:
Perrnittee Signature Approved Date
1 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 Signature
Fees Paid$ 16.00 $25_00 Date Init
(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 perrnittee at a rate of $50.00 per hour with a $25.00 (1/2 hour)
minimum. Permittee signatJre 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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NORM'S EXCAVATING, INC.
P.O. Box 574
Veradale, WA 99037
Phone (509)928-0580
Fax (509)892-0432
DATE � 7 /-/e)•.r
DELIVER TO Kathy or Dawn or Mike COMPANY City of Spokane Valley
PHONE 688-0036
• FAX 688-0037
FROM Sheila Gibbons PAGES INCLUDING COVER LETTER "'3
RE: Plumbing Permits
COMMENTS:
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