2006, 09-08 Permit App: 06003591 Approachpt.Ek`��
Community DIevelopm:nt
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Approach Permit Application
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PROJECT ADDRESS 1�3� �t E�--
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Building Owner:
Contractor:
Name: V tk1.r '.\
Address: -e -
City: ta��C�Sa�i1 State: Zip:
Phone: �� `"7� �ilv Fax: ,`-cfr::,
Contact Person
Name:
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PROJECT DESCRIPTION- TON (Provide site sketch)
Residential Driveway
Existing Curb ti. Gutter
Culvert: Installation
Other Conditions
Name: 41,-\.0
Address:
City: State: Zip:
Phone: Fax:
Contractor Lic No: Y l Y l mf. tcatei,,,mExp Date:
City Business Lic. No:
Commercial/Industrial Driveway
Rural Road Section
Sidewalk Repair/Coast:ruct:ion
Bond/Insurance certification mus: 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 dawclling, 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 pennit 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.
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JO e L,J o c1 01
Cash ❑ Check
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Date 1(
❑ i;lastercard ❑ VTSA
�.rtho_ized Signature:
REVISED 3'9/0E