2014, 12-11 Permit App: APR-2014-0128 ApproachSp"Okane
jUalleye
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 720-5240
Fax: (509) 688-0037
permitcenter@sookanevallev.org
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
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APPROACH PERMIT APPLICATION
PROJECT ADDRESS:
START DATE:
BUILDING OWNER NAME: L4)L. 14 b rK e
53/0 A) . R tm124,
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ANTICIPATED COMPLETION DATE:
034- 992(c,
MAILING ADDRESS: (2 1 b A). LL A3
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CITY: 5 p KA Q-- (Jft I (e STATE:
CONTACT PERSON NAME: liT .1 P er-
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ZIP: (J.
PHONE: 5 Del 1 -'� 1)- i FAX: 9a- )- - O i 9 5"
CONTRACTOR NAME: L A L 4 p -n -. 4. L 1.--
6/10
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CITY: 5p p ti Q V {} ((Qy STATE: L) 4.
MAILING
MAILING ADDRESS:
CELL: a (7 - (O -5—
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1 q 5'ZIP:
PHONE: `�Oq-q;�q-(.) l
( 1 FAX: c;Q--OI !
CONTRACTOR LICENSE #: 1.0A3 L Ito lq (. $% $ EXPIRES: 4 -7
Residential Driveway
❑ Existing Curb & Gutter
❑ Culvert Installation
0 Other Conditions:
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CELL: 1 )-lOS
/ (e) CITY BUSINESS LICENSE #:
PROJECT DESCRIPTION (Please Provide Site Sketch) p r o t e c t
0 Commercial/Industrial );riveway
❑ Rural Road Section
Sidewalk Repair/Constriction
SUR --
RECEIVED
DEC 1 1 2014
PERi:1; iT CENTERS
Bond/Insurance certification must be on file with 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
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Date: \
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