2012, 11-21 Permit App: APR-2012-0072 ApproachSpokane
Valley
Community Development Department
ofermit Center
1703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter@spokaneva Iley.orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
-t #liPR-1z-7Z-/60-12-213`
APPROACH PERMIT APPLICATICRECEIVED
PROJECT ADDRESS:
START DATE: /2,_
/ `J LG> N/,9 / Cs/2 Gc'
ANTICIPATED COMPLETION DA
2012.
BUILDING OWNER NAME:
MAILING ADDRESS:
%/5
CSV PERMIT CENTER
SUB # L } REV. #
CITY: 677-71-.c.. r'rt//}Glt c;) STATE: /(2.41-S..4- ZIP:
CONTACT PERSON NAME: `) 7-C3- t 2 `e_
PHONE: �j� b - � / - / �'? 4. FAX:
CELL:
CONTRACTOR NAME: lea- c. 7, . F_
r
MAILING ADDRESS:
/9L)
CITY:
Pe9--J STATE:
PHONE: ,SO. " Y94/ - 3 //
ZIP: �S
FAX: CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
PROJECT
esidential Driveway
O Existing Curb & Gutter
O Culvert Installation
0 Other Conditions:
DESCRIPTION (Please Provide Site Sketch)
O Commercial/industrial Driveway
O Rural Road Section
O 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 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.
�e-114-e----
Signature
Date:
Updated 1-11-11 Page 1 of 1
http://www. spoka n eva Iley. o rg/fi l estorage/ 124/938/210/948/ 1496/Approach_Perm it_1-11-11. doc
Community Develzpment Department (Staff Use Only)
flitermit Center
SpokaneSpokane Valley, WA 99206
1703 East Sprague Avenue, Suite B-3 PERMIT NUMBER:
Valley Tel: (509) 688-0036 PERMIT FEE: . to
Fax:(509)688-0037
permitcenter@spokanevallev.orq Project #%f f "g- /Z- 72d f3/c/-k
APPROACH PERMIT APPLICATIOI1iVE Oia-1z
PROJECT ADDRESS: / 5 5 ,°,,U e i ,6,t �`2r NQV � 7
START DATE: 04r G. ANTICIPATED COMPLETION DATE: F
CSV PERMIT CENTER
BUILDING OWNER NAME: j-, p .. �,�e,�1 ,-_--
I Jt..JC:5 PEV.#, 1
MAILING ADDRESS:
CITY: —y2..e r {i �� STATE: /),14-5 ZIP: VBG/
Z13`S
_Z13 r
CONTACT PERSON NAME: 571–e i9 0.4J
PHONE: 643 12g , O, a FAX:
CONTRACTOR NAME:
MAILING ADDRESS:
CELL:
CITY: r DL -
PHONE: 509-�y'
STATE:Y..
CT -712P
ZIP:
55`
FAX: CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
PROJECT DESCRIPTION (Please Provide Site Sketch)
Residential Driveway ❑ Commercial/Industrial Driveway
❑ Existing Curb & Gutter
❑ Culvert Installation
❑ Other Conditions:
❑ Rural Road Section
❑ 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 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 thls 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: ///Z—
Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Approach_Permit_1-11-11.doc
PLANNING DEPT. APPROVED
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