2006, 04-20 Permit App: 06001524 Approach_fi t
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Com nuairy Deveto pn- n:
Approach Permit Application
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PERI :.. FEE
PROJECT ADDRESS L n1..yZ
S1; Z1 DATE
�l ICI- i- TED 1Jil'l..,E i 1 01\T DATE
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Building 0-ii,,i'i7er
Contractor:
Name: V it!,(p , i
Name: 5i l�Q
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Address:.! S ! x) ,. A-
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State: Zip:',
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Zip:
Phone: )ck, 7 _qk f', c,
Fax: <�13t'., iu)4.--Ci.cL1
Phone: Fax:
Contact Person
Contractor Lic No: Exp Date:
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Name:
City Business Lic. No:
Phone: .,---) .-cki. >( ,
PROJECT DESCRIPTION (Provide site sketch
Residential Driveway
Existing Curb & Gutter
Culvert Installation
Crier Conditions
Commercial/Industrial Driveway
Rural Road Section
Sidewalk Repan -/Construction
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.
Signature ---CAIJ
IN5):
A-U.,\0\-Nt Date "l t9 I LJ(;)
1VreJ.,od of Pavmene:
❑ Cash Li Check ❑ Mastercard ❑ VISA
Bankca d =. ._ :
utho-zed Signature: