2008, 03-28 Permit App: 08001095 ApproachCommunity Development
Approach Permit
Permit Center
11703 E Sprague Ave, Suite B -3
Spokane Valley, WA 99206
(509)688 -0036 FAX: (509)688 -0037
www. spokanevalley. ora
Application
PERMIT NUMBER:
PERMIT FEE:
PROJECT ADDRESS
START DATE
ANTICIPATED COMPLETION DATE
PROJECT DESCRIPTION (Provide site sketch)
Residential Driveway
Existing Curb & Gutter
Culvert Installation
Other Conditions /
Commercial /Industrial Driveway
Rural Road Section
Sidewalk Repair /Construction
S -729,I tv 4 J.
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 cP
Method of Payment:
❑ Cash ❑ Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN #:
Authorized Signature:
REVISED 31W06
Building Owner:
Contractor:
Name: L / t1- /Zf d /De de 4,,,n4 ' <--
Name: 2' ar5 i .Ale. -',/4 wesT .rtte ,
Address: s'.61,170 (, je s k
Address: j.._. ye9 4_ , 4,..,', as,;, e , ry ..z , 41
City: 5400,-).,fr4.. a State: tag Zip: cyLe 8
City: �o irryt� ate: u/4 Zip: 9
41
Phone: ea3a'i- y'7 "7 Fax: .a.1- .. - V -47c
Phone: y'," ' - -gle [/ Fax: S _t Y -i "5- „�--
Contact Person
Contractor Lic No:��s� 41,� i ati I tt 9 _/ i _ 9 g
Name:
City Business Lic. No: L 0* t/ ,s-49 6
Phone:
PROJECT DESCRIPTION (Provide site sketch)
Residential Driveway
Existing Curb & Gutter
Culvert Installation
Other Conditions /
Commercial /Industrial Driveway
Rural Road Section
Sidewalk Repair /Construction
S -729,I tv 4 J.
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 cP
Method of Payment:
❑ Cash ❑ Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN #:
Authorized Signature:
REVISED 31W06