DRVA2017-0009TV,\2ofl -cccM
DRIVEWAY APPROACH PERMIT APPLICATION
Applicant Information:
Applicant/Owner (p/ease print name here): ,4ree, ,ai
Applicant Address: ¼i39JS
Number Street City State Zip Code
Addréssor Parcel No. of work location, if different from applicant's addressabove:
Number Street City State Zip Code
Date: Applicant's Phone No: (1) VS11
Applicant's
Approximate Start Date: /J2-/ fl Approximate Completion Date:
Contractor Information:
Address:
Number Street City State Zip Code
Phone Number: (I _Contractors License Number:
City Business License Number:
General Liability Insurance Company: Policy No.
Request for Inspection - Please call (760) 777-7097 before 1:30pm to request an inspection at least 24
hours prior to your requestedinspection date. The Hub Counter (760) 777-7125.
Please Note: Inspections are normally performed Monday through Friday between 8am and 4pm
Permit Fee $152 + $5 Technology Enhancement Fee = $157 Total Fee
Permit N6?1-1_xpiration Date 3/'L/Jj
Permit Issued by: Date Issued
gnre 0
Work Inspected by: Permit Completion Date: /1
Inspector's Signature
Comments:
Note; Driveway approach must be constructed per City of La Quinta Standard #221