2007, 04-18 Permit App: 07001321 App Scm Permit Center PERMIT NUMBER: ' 1
pokane 11707 E Sprague Ave,Suite 106 f '
.000Valley Spokane Valley,WA 99206 PERMIT FEE:
(509)688-0036 FAX: (509)688-0037
Community Development www.spokanevalley.ora
Approach Permit Application
PRO ECT ADDRESS d ��,6-Cir t 5
107 �ive 5f -L
START DATE ANTICIPA 1'LD COMPLETION DATE
L/ /Z6/o f�;-/3t3/'d7
Building Owner: Contractor:
Name: j-� ;� L vj ,, Name: /3 G �ryf
Address: C y 14'7 /r, ./. �( ,` Address: r G /n 7 !1 f v e S/�.l P
City: S State:WA Ztp:9 414 io City: �> a �.-• Gl["ra State: Zip: yo/G
Phone: 3 3 10 6 Fax: q LLt 7 St( Phone: . 9/ 7 7 Li4, Fax: 5 LC 7 j C�
Contact Person 6 reAtiC Contractor Lic No:Ra3l3
!,G/'V1/_0,El— $y;t 2,s.'f `Zoc:
Name:
7 City Business Lic.No:
Phone: QJ , '310 j
PROJECT DESCRIPTION (Provide site sketch)
RResidential Driveway Commercial/Industrial Driveway
Existing Curb&Gutter Rural Road Section
Culvert Installation Sidewalk Repair/Construction
Other Conditions
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 a `4 i --- Date L// 41/ d 7
Method of Payment:
0 Cash ❑ Check ❑ Mastercard �SA
Bankcard#: Expires: VIN#:
Authorized Signature:
REVISED 3/0/O6