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DRVA2017-001892 lID? A L IIrr S j SEP O 8 2017 I CITY OF LOUJ Y DRIVEWAY APPROACH PERMIT APPLICATIOF UNIRTNYD EWPDN Applicant Information: Applicant/Owner (please pijol name here): --- Applicant Address: Number Street S City State Zip Code Address or I No. of work different from applicant's address above: Number Street City State Zip Code Date: Th Applicant's Phone No: (_7CC) 77 S. \' Applicant's Signature: Approximate Start Date: / ' / \ 1 Approximate Completion Date: / & / Contractor Information: Address: CA. Number Street. City State Zip Code Phone Number: (7L 0) 7 7 S - I i '.i Contractors License Number: 1 G 1 City Business License Number: General Liability Insurance 'cS Policy No. 1c \O) '33O-S Request for Inspection - Please call (760) 777-709.7 before 130pm to request an inspection at least 24 hours prior to your requested inspection date. The Hub Counter (760) 777-7125. Please Note: Inspections are normally performed Monday through Friday between 8am and 4pm Permit No. Deli/4rn7—p's ExPiron Date i i r / Permit Issued . Date Issued i / 1 7 't-ignatur& of Admfntrative Authority Work Inspected by: S Permit Completion Date: / / Inspector's Signature Comments: Note: Driveway approach must be constructed per City of La Quinta Standard #221