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DRVA2017-0007V(lU1oti- oco7 1cTocL DRIVEWAY APPROACH PERMIT APPLICATION Nnance Kevenue Code PD Applicant Information: Applicant/Owner (please pjjt name here) Applicant Address: Number Street - City Stäte Zip Code Address or Parcel No. of work location, if different from applicant's address above: Number Street City State Zip Code Date 2_/jIJ Applicant's Ph .io (1t2.)) 15) cas Applicant's Signature Approximate Start Date: Approximate Completion Date: Contractor Information: ~ I f , ~-) Address Number - Street City State Zip Code Phone Number: Contractors License Number: City Business License Number: I General Liability Insurance No. Request for Inspection - Please call (760) 777-7097 before 1:30pm to request an inspection at least 24 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 I Permit Fee 1Z5-= *wq.iotal Fee Permit No.t2* ori-1- Expiration Date jiiS , S Permit Issued by:1 . Date Issued Sidn ãf'4rnjistra ye Authority Work Inspected by:: Permit Completion Date: Inspector's Signature Comments: . -- Note: Driveway approach must be constructed per City of La Quinta Standard#221