2012, 05-09 Permit App: EGR-2012-0012 Erosion Control •
Community Development Department
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11������ Permit Center (Staff Use Only)
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206 PERMIT NUMBER:
Tel: (509)720-5240
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Fax: (509) 688-0037 PERMIT FEE:
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GRADING PERMIT APPLICATION S'/1 i°- O 7`1/
SVMC 24.50 LAND DISTURBING ACTIVITIES
ROUGH/CLEARING 0 FULL GRADING 0 UNDERGROUND ASITE
SITE ADDRESS: / O(3& 10 11 £ 9T4 4ve4c— / 0 GIP frolor✓rti
ASSESSORS PARCEL NO.: ilSZc(,oc31. G SCRIPTION: Aecef. A&C/3 c, smici 6• g4-11 Z
0cmm, 5-L6r,os3y 431
PROPERTY OWNER NAME: &OCfr.b- LLL
Pa(MAILING ADDRESS: /�a( 'V 765'
MANAGER: /_/
Cm: t/6/14/4(I�i STATE: INA- ZIIPPJ: q9,37
PHONE: FAX: CELL: ? —9 2 97
CONTACT NAME: fl/C/j ,S/a
PHONE: FAX: CELL:
EXCAVATION CONTRACTOR NAME: . T*-Cl, 14-64-w tz_1 N S T L X1/45
61(cA-v,4i-i )
MAILING ADDRESS: 1 / Z Z 6 K.)-0 CA-
CITY: S iv e.._
e a h- STATE: • t ZIP: � .Z-o
PHONE: 50? 7 ii/ d o Zs (d$fo38)AX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
COMPANY NAME: 1-130 RECEIVED
MAILING ADDRESS: CSV PERIVN T CFNTFR
CITY: STATE: ZIP: }Ay u 9 2012
PHONE: FAX: CEELI2Dject ` • -0 ''Pate
CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSIII&C113 i.. •
Submitta;4 1
SOIL TESTING FIRM NAME: 0i'
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: CELL:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
C4-6157/"uer Pi',.'#'j tG ,OAI 'e ,-c7 4kid f7 ' c1 ' ,':I,9G 7Ct<<%!7
ESTIMATED EXCAVATION/CUT (CUBIC YD):
1Ld/-- CY
BD-03 V-1.0 Page 1 of 2
ESTIMATED EMBANKMENT/FILL (CUBIC YD): ((A
DESTINATION OF EXCAVATED MATERIALS: oaj 5,` G fr 7' ft Pds
START DATE: 2012 ESTIMATED COMPLETION DATE: ci(
( oarz
DISCLAIMER
The permitted verifies,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 for 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.
Signature "If
j Date: -6-72-
•
BD-03 V-1.0 Page 2 of 2