2014, 10-09 Permit App: APR-214-0106 Approachcm• of
Spokane.
jValleyY
Project #ArQ' I (42.7 n 10(0
RECEIVE
Community Developme5t�$ep r en�os
Permit Center II
11703 East Sprague Avenue, Suite B-3
SpoksneValleyr9H0E6RMIT CENTER
Tel: (509)720-520
Faxit¢$$ r7
perm:cits evall v.olig REV. _
(Staff Use Only)
PERMIT NUMBER:
PERMITFEE:
APPROACH PERMIT APPLICATION
PROJECT ADDRESS: § 3 b( AD 14 0 L. o Ai
START DATE: /D - 9 - 02o / y I ANTICIPATED COMPLETION DATE:
BUILDING OWNER NAME: L. -A)I,.-
L, (40 PK es 1. LC.
MAILLNG ADDRESS: 0- t t )• J N O P i 5 I.
i
CITY: 0 ki- /L) �)/}C/2 t� STATE: x)4 •
CONTACT PERSON NAME: • le e I u- p e- r
PHONE: ('j C9 q aq- La 1 I FAX: roc, O ) / Z/ -alp 5 CELL:
/ 9 -o20f5-
� �.
3o&
ZIP:
CONTRACTOR NAME:
MAILING ADDRESS: C2 f D /U • a iu' ' J s f 1 c . 4 3-0-v
CITY: 590 kA-AJc OdOddle_ Li STATE: ZIP: 7 /�7 o
PHONE: (5-09) I a II ' l a- l / FAX: (-5 e 9) 9 a - O l 9 .5 CELL:
CONTRACTOR LICENSE #:
EXPIRES: CITY BUSINESS LICENSE #:
4 Residential Driveway
I] Existing Curb & Gutter
Culvert Installation
I] Other Conditions:
PROJECT DESCRIPTION (Please Provide Site Sketch)
0 Commercial/Industrial Driveway
Rural Road Section
0 Sidewalk Repair/Construction
Bond/Insurance certification must be on fele witis the City.
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction 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) The 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
DE -001: V-1
Date: 1O — `— \
Page 1 of 2