2003, 06-16 Permit App: 03-368 Approach�q ¢
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Spo"kan�
�Valley
Anticipated start date
Call 24 hours before inspection required
Phone 509.688-0036 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Permit # PW L-:� ��1 � r
APPROACH PERMIT
APPLICATION
Location of property -7-3)
(A dress/Parc , if aailable)
Applicant Name ���
Address
Contractor's Name
Address
Contractor's Reg#
PROJECT DESCRIPTION (Provide site sketch)
IFT Residential Driveway
❑ Existing Curb & Gutter
❑ Culvert Installation
❑ Other conditions_
Phone
Phone
Expires
❑ Commercial/Industrial Driveway
❑ Rural Road Section
❑ Sidewalk Repair/Construction
See construction requirements and details on reverse. Bond/insurance certification must be on
file with the Citv.
SPECIAL CONDITIONS:
PERMIT FEE $ Inspection Fee$
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card # Expiration Date,
Name of Holder Signature
Fees Paid$ J 0 , e -p Date _ (A I& Init