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2009, 05-29 Permit App 09001538 ApproachPermit Center 'crryOF TA„� 11703 E Sprague Ave, Suite B-3 r�Li Spokane Valley, WA 99206 o www. pokan 6 FAX: (509)688-0037 4;00www sookanevallev.ore Community Development Approach Permit Application (tea V/ r PERMIT NUMBER: 1 PERMIT FEE: PROJECT ADDRESS LI `O 's. W ✓\. c �LT START DATE Cotes \1 c4, g,e{ C ATED COMPLETION DATE ll `�t2t Building Owner: - [factor: Name:< - t Name: Address: Address: City;Unfikil State: Zi : Q City: State: Zip: Phone: q 10011 $' • 9 ry s Phone: Fax: Contact Person Contractor I.ic No: Exp Date: Name: O f City Business Lic. No: Phone: ZZ PROJECT DESCRIPTION (Provide site sketch) } V Residential Driveway ? El Commercial/Industrial Driveway <F-1 Existing Curb & Gutter F Rural Road Section ElCulvert Installation El Sidewalk R�Repair/ConstructionC,o-nstruction n Other Conditions W �- W ak l� 4ay-r— G Bond/Insurance ceitification must be on file with the 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 additional information may be required to be submitted, and subsequently approved before this application Signaturt Method of ❑ Cash Bankcard 1.. Authorized Signature: REVISED 3 Date � ' � t D / VISA VIN#: c w Project Number: 09001538 Inv: I Application Date: 5/29/2009 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Proiect Information: Permit Use: RES APPROACH Contact: KARNITZ, JOSHUA M Address: 4108 S CONIFER C - S - Z: SPOKANE, WA 99206 Setbacks: Front Left: Right: Rear: Phone: (509) 926-1395 Group Name: Site Information: Project Name: Plat Key: 004124 Name: PONDEROSA 04TH ADD REPLAT BI L2,3,10,11 (FEES) District: Sout Parcel Number: 45324.0121 Block: Lot: SiteAddress: 4108 S CONIFER CT Owner: Name: KARNITZ, JOSHUA Al Address: 4108 S CONIFER Location:: CSV SPOKANE, WA 99206 Zoning: R-3 SF Res District Water District: Area: 18,930 Sq Ft Width: 100 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Driveway/Approach Permits: crs'TL'Z�'7Ts�aIS'/U 517 Item Description APPROACH -CONST IN ROW Hold: O Depth: 189 Right Of Way (ft): 0 Released By: Firm: OWNER Phone: (000) 000=0000 Units Unit Desc Fee Amount 1 NUMBER OF $50.00 Operator: JD Printed By: JD Permit Total Fees: $50.00 Print Date: 5/29/2009 Project Number: 09001538 Inv: 1 Application Date: 5/29/2009 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Payment Summary: Permit Tvoe Fee Amount Invoice Amount Amount Paid Amount Owine Approach $50.00 $50.00 $0.00 $50.00 $50.00 $50.00 $0.00 $50.00 Disclaimer: Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the code or of any other state or local laws or ordinances. Signature: Operator: JD Printed By: JD Print Date: 5/29/2009