2009, 05-08 Permit App: 09001250 ApproachSpokane
Valley
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenterAspokanevalley.orq
APPROACH PERMIT APPLICATION
PROJECT ADDRESS:10907 E. FAIRVIEW
START DATE:
ANTICIPATED COMPLETION DATE:
BUILDING OWNER NAME:
MAILING ADDRESS:10907 E. FAIRVIEW
CITY:SPOKANE VALLEY
STATE: WA ZI P:99206
CONTACT PERSON NAME:ROBERT DUGGER
PHONE:509 891-1380
FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS:
CITY:
STATE: ZIP:
PHONE:
FAX: CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
PROJECT DESCRIPTION (Please Provide Site Sketch)
►®f Residential Driveway 0 Commercial/Industrial Driveway
0 Existing Curb & Gutter ❑ Rural Road Section
0 Culvert Installation ❑ Sidewalk Repair/Construction
El Other Conditions:
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 Date:
Method of payment: ® Cash
Bankcard #:
Authorized Signature:
0 Check
0 Visa ❑ Mastercard
EXP: VIN#
Effective October 28, 2007
C:\Users\482xp6j9wr4jxt3vbpp6\AppData\Local\Microsoft\Windows\Temporary Internet
Files\Low\Content.IE5\YSEMTDUX\Approach0/020Permit.l [1].doc
Page 1 of 1