2003, 07-14 Permit: RO-03-41 ApproachRPR 29 2003 16:48 FR
Anticipated start date
TO 12087624507 P.05/05
Call 24 hours before inspection required
Phone 509.688-0036 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
RV,
Permit It -OW 03 41
APPROACH PERMIT
APPLICATION
Location of property 1t Q
Applicant Name 6-Phone
Address Le,C 0,7). r't c'[t o �
t
Contractor's Name V
(Add ess/P
rcel #, if available)
Address
-et 10(0
Phone
Contractor's Reg# V \ \-'1\ _t q 3 Expires 2)1 L 1 101
PROJECT DESCRIPTION (Provide site sketch)
Residential Driveway
E Existing Curb & Gutter
• Culvert Installation
U Commercial/Industrial Driveway
Rural Road Section
n Sidewalk Repair/Construction
(Other conditionsJ)lf10tt„
See construction requirements and details on reverse. Bond/insurance certification must be on
file with the City.
SPECIAL CONDITIONS:
PERMIT FEE $
Ins • = ction Fee$
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card #
Name of Holder
Fees Paid$
Si nature
Expiration Date
** TOTAL PRGE.05 **