2006, 05-03 Permit App: 06001684 ApproachS toane --�
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Corm -nullity Development
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i 1712 F S_ -ague Suite O.
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Approach Permit Application
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PROJECT A DDRE:SS 1-13 03 \OrQ
START DATE ANTICIPATED COMPLETION DATE
Building Owner:
Name: (Tr.\
Address: �� aS 1k))!a 4<i
Ciry: l\P SIN State: Zip:k ik;`,; :"ic,
Phone: .)0(6--164-<-1101 v Fax: ;i yr,; = lhr4--ti,stj
Contractor
Contact Person
Name:
Phone:
PROJECT DESCRIPTION (Provide site sketch)
Residential Driveway
Existing Curb t: Gutter
Culvert Installation
Other Conditions
Li
Name: "Iy-vy
Address:
City:
State: Zip:
Phone: Fax:
Contractor Lic No: Y 1 mc 14(6,,,1Exp Date:
City Business Lic. No:
Commercial/Industrial Driveway
Rural Road Section
Sidewalk Repair/Construction
Bond/Insurance certification must be on file with the city.
DISCI-AB/LER
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 he 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. he required to he submitted, and subsequently approved before this
application can be processed.
Signature
method of Payment:
❑ Cash ❑ Check
Bznkc.rd =.
utho=zed Signature:
Date•
6)31
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