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2008, 08-28 Permit App: 08003400 Approach
r ScOtat Val leY Community Development Permit Center 11703 E Sprague Ave, Suite B-3 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-00$7A‘3 www.spokanevalley.org Approach Permit Application PROJECT ADDRESS lz)1 • $ ,y oil START DATE O - © 8 Building Owner: Name: Address: City: Phone: Contact Person Name: Phone: State: Zip: Fax: PROJECT DESCRIPTION (Provide site sketch) Residential Driveway Existing Curb & Gutter Culvert Installation Other Conditions Bond/Insurance certification must be on DISCLAIMER The permittee verifies, acknowledges anc dwelling is/will be served by potable wa signatory is the property owner or has pe: full compliance with the City of Spokani Valley Permit Center. 5) This City of Spc codes or ordinances. 6) Plans or additi application can be processed Signature PERMIT NUMBER: *.S PERMIT FEE: ANTICIPATED COMPLETION Contractor: Name: (t t-fr. Y1i-- Address: 1 1 2 U City: (,'. Phone: 6'G9-� 33 Contractor Lic No: City Business Lic. No: State: (Jfr1 Zip:9/637 Fax: 9-7Z, f _51,00 Exp Date: Commercial/Industrial Driveway Date struction or construction of or on a dwelling, the mit inure to the property owner. 3) The :tion. 4) All construction is to be done in rilable for review at the City of Spokane y violation of federal, state or local laws, and subsequently approved before this Method of Payment: ❑VISA ❑Other ❑ Cash ❑ Check ❑ Mastercard Bankcard #: Expires: VIN#: Authorized Signature: Effective October 28, 2007 P:\Community Development\Forms\Building forms\Approach Permit eff 10-28-07.doc eLioAcirc'4 --o ire aiY\oveA �-- 3z lr\ovvr\oiTh a