DRVA2014-1006K.
CH PERMIT APPLICATIO
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Date iOW°4. Ap shoe Noagg
Applicants Signature
Approximate Start Date /pproximate Completion Date
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Number Street ...StitéZiCóde
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City Business License Number
General Liability Insurance Qmpan MERCURY PoLiyNo
Request 1tion Plthsé calf 7777O 9f before 1:30pm to request an inspection at/east24 -
hours prior to your requested inspection date. Public Works Counter (760) 777-7075.
Please Note: Inspections are normally performed Monday through Friday between 8am and 4pm
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J ermit Fee$1Q $1zctfee .....1.Lf
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Permit Issued by - Date Issued
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Work Inspected by . Permit Completion Date
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"Noth:briveviáyápfr&àch must be cóiistrüôtëd per City of La Quinta; .Standard #221