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2007, 09-13 Permit Application: 07003641 Approach
Spokane � jValley9 Community Development Permit Center 11703 E Sprague Ave, Suite B -3 RECEIVED B Spokane Valley, WA 99206 CITY OF SPOKANE VA (509)688 -0036 FAX: (509)688-0032 1 3 2 07 www.spokanevalley.org SEP PERMIT CENTER BY Approach Permit Application , PERMIT NUMBER: PROJECT ADDRESS ' J START DAM Z•S © j ANTICIPA1 "E,D COMPLETION DA 1E 7� "� Building Owner. Name: PA. \ Address: D ":C��k: \..4\ �p(0 City: pN�last \b„ k \a State: U-)N Zip:°MZ`C\ Phone: DC ) - 2 �- �"Z?jQ Fax: Name: Phone: S0") ". PROJECT DESCRIPTION (Provide site sketch) [y] Residential Driveway Existing Curb & Gutter Culvert Installation Other Conditions Contractor. Name: 0 Address: City: State: Zip: Phone: Fax: Contractor Lic No: Exp Date: City Business Lic. No: Commercial /Industrial Driveway Rural Road Section Sidewalk Repair /Construction Bond /Insurance certification must be on file with the city. DISCLAIMER The permittee verifies, acknowledges and agrees by their signatures that 1) If this permit is for construction of or on a dwelling, the dwelling is /will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the property owner. 3) The signatory is the property owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional information may be required to be submitted, and subsequently approved before this application can be processed. Signature Date 9// 3/CY7 Method ofPayment .. ❑ Cash ❑ Check ❑ Mastercard ❑ VISA Bankcard #: Expires: VIN #: Authorized Signature: REVISED 3/9N5