2012, 09-15 Permit App: APR-2012-0062 Approach F _
Sep. 15, 2012 2 : 31PM FRED MEYER #332 PRX 509-489-0248 No, 3952 P. 1
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Community Development Department (Staff Use Only)
PeSpaa 11703 EastSpCenter
11703 Sprague Avenue,Suite B-3 PERMIT NUMBER'
Spokane Valley,WA 99206 PERMIT FEE
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ValeY
4000 Tel:(509)762880
Fax:(509)68&0037
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APPROACH PERMIT APPLICATION
PROJECT ADDRESS: (2305- c . 2427714/ _c4-4.✓E 14 - ye- M 412./6
START DATE: if—/? -/ L ANTICIPATED COMPLETION DATE: - 2 6 -J Z
BUILDING OWNER NAME: .-'Of4�/ Pe C 7/L
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MAILING ADDRESS: / 2 3 Os C. 0 U 731 .4 d-
CITY: C2.9 t-i9.✓t V4t 7 STATE: /9 ZIP: get-2/
CONTACT PERSON NAME: i J /47'1- / /e 7�
PHONE: '51.,fy- z25-o J 7 I FAX: $ - 43./1 -- 1221/e CELL: 5 ?- 4,99-94-67,37
CONTRACTOR NAME; /�
MAILING ADDRESS: £ ,9,Vr 4-5/31//4i-rj/3 - #0/17Ice64"
CITY: 5 PPKAIVSTATE: 1-174/ ZIP: .qZ2 y
PHONE: So/- 2 2L- ?9q9 1=AX: 5-0 -"C/2.2..- /30,5 CELL: S r/" eave)
CONTRACTOR LICENSE#: EXPIRES: CITY BUSINESS LICENSE#:
PROJECT DESCRIPTION(Please Provide Site Sketch)
€ 'i: Residential Driveway NI Commercial/Industrial Driveway
IN Existing Curb&Gutter Mr Rural Road Section
an Culvert Installation MI Sidewalk Repair/Construction
IN Other Conditions: -
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Bond/Insurance certffrcation must be on file with the City.
PISCLAIMER
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.
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Received TimecSep. 15. '2012=4 2: 13PMINo. 99U7�/' 9/9/6..5