2014, 09-26 Permit App: APR-2014-0092 Approach Community Development Department (Staff Use Only)
Permit Center
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S11703 East Sprague Avenue, Suite B-3 PERMIT NUMBER:
pokane Spokane Valley, WA 99206
Valley Tel: (509) 688-0036 PERMIT FEE:
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Fax: (509) 688-0037
perm itcenter@ spoka neva l ley.orq
APPROACH PERMIT APPLICATION
PROJECT ADDRESS: f ® e) k oD 1 Ct (-4A...)
START DATE: 9 12,62 \a3 (LI ANTICIPATED COMPLETION DATE: '/�Q .1 )
310 1 (7
BUILDING OWNER NAME: La 1-7 lo\-P,1)-;-o1 f''( 7 --
MAILING ADDRESS: ` UO \ L. 1 I kk...)
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CITY. V ILJ,. Uri l STATE: 'Ai1 l ZIP:
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CONTACT PERSON NAME:
' (� -aCY L (11
C.)PHONE: C- ( C.j 7c7 - . t L FAX: (� la Cor\ CELL: 19 `7c 1 qCONTRACTOR NAME: k�1 \ JC.(�( (--Q,c,vt 'dr -2 tn. ti
MAILING ADDRESS: c) e: U �C_.) CD
CITY: '_) LC,),—.12_
/C .QGl_� WPSTATE: Acca, j i ZIP: 1 t
PHONE: $7 a lc( FAX: s'�I \ a_ CELL: ' l C� -7a l\�
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.: • ..
PROJECT DESCRIPTION (Please Provide Site Sketch)
Residential Driveway E Commercial/Industrial Driveway
0 Existing Curb &Gutter 0 Rural Road Section
Culvert Installation D Sidewalk Repair/Construction
0 Other Conditions:
Bond/Insurance certification must be on file with the City.
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 permit or approval for any violatio • -:eral;-State or local laws, codes or ordinances. 6) Plans or additional
information may be req edr be subki e. . d s.. - y approved before this application can be processed.
t Signature t, , � I I V_ Date �1 J I (Ao
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Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Approach_Permit_1-11-11.doc