2009, 10-12 Permit App: 09003284 Approach gra `rte Permit Center
11703 E Sprague Ave, Suite B-3 PERMIT NUMBER: ��L
4000111g Valley Spokane Valley,WA 99206 PERMIT FEE: —
Community Development (509)688-0036 FAX:(509)688-0037
www.spokanevalley.org
Approach Permit Application
PROJECT ADDRESS . Q,-. / mL it tV
START DA 1'E 0 1, .//0' ANTICIPA IED COMPLETION DA 1'E 0 /
Building Owner: Contractor:
Name: Name: / Min- y/�,L5
Address: / 3 rip OZ O� �# Address:/ . "/\/. /!��lCity: 4K�e I1//l/� State: //, Zip: City: /e/,u /4 e: /N Zii 9 /Phone i Fax: � Phon� 7I i2_ Fax:50q ••02 L/4/^9994/
Contact Person Contractor Lie No
Name: 1f O /�
City Business Lic.No:
Phone:
PROJECT DESCRIPTION (Provide site sketch)
Residential 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 adslitional information may be required to be submitted, and subsequently approved before this
application can be processed.
/ I i le/4/2 -9
Signature /% Date
Method of Payment:
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature:
Effective October 28,2007
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