2007, 04-23 Permit App: 07001432 Approachp E � '0"E
Sr�T'orkane . Permit Center + v I PERMIT NUMBER:
11707 E Sprague Ave, Suite 106
4,,0•0Valley Spokane Valley, WA 992��'R 2 PERMIT FEE: -
(509)688-0036 FAX: (509)688-00y C
Community Development www.spokanevalley.org
Approach Permit Application
PROJECT ADDRESS �tj"�^ �� wU , Qq zff-j�
START DATE ANTICIPATED COMPLETION DATE
PROJECT DESCRIPTION (Provide site sketch)
Contractor:
Name:
Address:
City: State: Zip:
Phone: Fax:
Contractor Lic No: Exp Date:
City Business Lic. No:
1-1 Residential Driveway 1-1 Commercial/Industrial Driveway
Existing Curb & Gutter FI Rural Road Section
Culvert Installation Sidewalk Repair/Construction
1/I Other Conditions VCn �[ ,► �n n
Bond/Insurance certification must be on file with the city.
DISCLAIMER
The permittee verifies, acknowledges and agrees by their signatures that: 1) If this permit is for construction of 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) This 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
i
Signature /, Date 'T
Method of Payment.•
❑ Cash ❑ Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 319/06
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