2011, 08-04 Permit App: 11002562 ApproachISLE '°N WdSO : l 110Z 'ti
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 720-5240
Fax: (509) 688-0037
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(Staff Use Only)
PERMIT NUMBER;
PERMIT FEE:
APPROACH PERMIT APPLICATION
PROJECT ADDRES$1306 N BURNS RD
START DATE:08/05/11
BUILDING OWNER NAME:SADIE RUECKERT
MAILING ADDRESS: 11201 W 2151- AVE
CITY:AIRWAY HEIGHTS
ANTICIPATED COMPLETION DATE: 8/09/11
STATE: WA
ZIP: 99001
CONTACT PERSON NAME: JAYSON GRAINGER
PHONE:466-5555 FAx:4683719
CELL: 9394549
CONTRACTOR NAME: CAMERON-REILLYLLC
MAILING ADDRESS: SAME
CrrY:
STATE:
ZIP:
PHONE:
FAX: CELL;
CONTRACTOR LICENSE #:ON FILE
EXPIRES: CITY BUSINESS LICENSE #:ON FILE
PROJECT DESCRIPTION (Please Provide Site Sketch)
Residential Driveway
Ell Existing Curb & Gutter
E' Culvert Installation
Ei Other Conditions:
El Commercial/Industrial Driveway
Rural Road Section
'l Sidewalk Repair/Construction
Bond/Insurance certification must be on file with the City.
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) If thls 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 Clty of Spokane Valley
Development code. Referenced codes are available for review at the City of Spokane Valley Permit Center, 5) The Clty 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'requlred to be
submitted and subsequently approved before this ap• cation can be processed.
SignatureDate:
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ane
Permit Center
71707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development WWW.spokan ev alley . org.com
ROW Constructionttopmacii.
XDriveway " o Pavement Cut **(see below)
o Sidewalk 0 Curb & Gutter 0 Other
Road Obstruction Noo Yes (traffic control plan requirec
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PER1'11T UMBER:
PERMIT FEE:
Permit Application
PROJECT ADDRESS a"Cor
START DATE S -
(z
ANTICIPATED COMPLETION DATE
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Phone: Fax:
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Name: wStajaf,+&,. 1
Phone 41t4ww,-.41.01ti2t---. 4.14pci --s, —
**MUST BE COMPLETE IF PAVEMENT CUT**
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CitY: A-:".4kZ4 1L),+s Zip: 49902L.
Phone: 4(40 - ,s -Ns. Fax: ...WE,- se? (4
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- City Business Lie No: 64% ,6•i4-
Tier
Type of Work Condition of Cut
Gas Sawcut
Electric Grind (pm -approved only)
Water
CATV
Conamunications
Sewer
Other
Tyne of Repair Existiag Road Condition
ibait Depth of Asphalt
oncrete Depth of Gravel
Asphalt
Width Length
X
X
X
Concrete
Width Ltaigth
X
X
X
..,..,- • •
BOND[INSTJEANCE CERT #
Signature
Cs (PER' SVIVIC TIELE 10 ARTICLE 2)
Date
Method of Paym Faxed perm app ications will only be accepted with major bankcard)
0 Cash fl Check 0 Mastercard 0 VISA
Elankcard #: Expires: VIN#:
Authorized Signature:
0 Other
Work completed satisfactorily Date
(INSPECTOR)
PLEASE FAX TO CITY OF SPOKANE VALLEY UPON COMPLETION (509)688-0037
NWMED iirmaf
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