HomeMy WebLinkAbout2015, 04-14 Permit App: APR-2015-0028 Approach pr. 14. 2015 07 :07 AM IM PAGE. 1/ 2
Conununity Development Dcparunent Permit (Staff Use Only)
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cm( 11East Spcaguc Avenue,Suite B-3 PERMIT NUMBER:_.�
Spokane Valley,WA 99206
Tel: (509)720-5240 PERMIT FEE:
40001010ValleY.. Fax:(509)688-0037
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APPROACH PERMIT APPLICATION
PROJECT ADDRESS: / 9 J S W0z4 I xoY1 /
START DATE: OCi/i -j -y ANTICIPATED COMPLETION DATE: q //(0, /J CS—
BUILDING OWNER NAME: _ o k n�(AA -e,r JJJ r
MAILING ADDRESS: aAa 111 1 S 1 0004 ( a.u
�CITU: Z�)P�c.�r STATUE: V \-^ #a l 6
CONTACT PERSON NAME: S r % A & , / / _
PHONE: 9 ao., 52 _... Fax: i 1 C7'�_ 1 W ( t CELL: V,S f111J c
CONTRACTOR NAME: Y'"tl3l Vly C o c e f_e ,,.i '_'13
MAILING ADDRESS: • � � eLigoasaliod_CL - .L /7�
Ciro: 0 Z4_ , STATE: ( . _ � ZIP: lC g (c
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PHONE: i. d ' A . FAX: a �_ A. A. CELL: s ^. I 4
CONTRACTOR LICENSE##:AcklattiOk10r EXPIRES: ______ one, CITY BUSIlNESS LICENSE#:
PROJECT DESCRIPTION(Please Provide Site Sketch)
la Residential Driveway ❑ Commercial/Industrial Driveway
El Existing Curb&Cutter El Rural Road Section
❑ Culvert Installation ❑ Sidewalk Repair/Construction
0 Other Conditions:
•
Bond/Insurance certification must he on file with the City.
piscLAINIER
The permitted verities, acknowledges and agrees by their signature that: 1) if this permit is for construction 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 fur review at the City of
Spokane Valley Permit Center. 5) The 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.
•
Si_ ature _, .,,,„ ..I Date:
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Page 1 of 2
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Received Time Apr. 14. 2015 7: 05AM No. 1713
11707 E. Sprague Ave., Suite 108 Receipt Number: 201500999
oo iane Spokane Valley,WA 99206
.0000Valley. (509)720-5240
permitcenter@spokanevalley.org
Payer/Payee: CUSTER, JOHN&JULIE Cashier: CTHOMPSON Date: 04/14/2015
1221 S WOODLAWN RD Payment Type: CREDIT CARD
SPOKANE WA 99216-0534
APR-2015-0028 APPROACH PERMIT 1221 S WOODLAWN RD
escription Fee Amount Amount Paid Fee Balance
Approach $52.00 $52.00 $0.00
APR-2015-0028 TOTALS: $52.00 $52.00 $0.00
TOTAL PAID: $52.00
Printed 04/14/2015 14:00:00 by Chris Thompson Page 1 of 1