DRVA2017-0020OF DRIVEWAY APPROACH PERMIT APPLICATION
Applicant Information:
Applicnt/Owner (please Q name here: 1iC.
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pphcant Address:: c; 92-zcg
Number Street City State Zip Code
Address or Parcel No. of work location, if different from applicant's address above:
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Number Street City State Zip Code
Date: ii.i t7 Applicant' hneNo:
Applicant's Signature: c )
Approximate Start Date: 'i /Af t/ Ui Approximate Completion Date: I wxi
r Information;
Number Street City
Phone Number: (ILo ) '
. Contractors License Number:
City Business License Number:
General Liability Insurance Company:
State Zip Code
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: The Hub. Counter (760) 777-7125.
Please Note: Inspections are normally performed Monday through Friday between Barn and 4pm
Permit Fee $152 + $5 Technology Enhancement Fee = $157 Total Fee
Permit No. 62 VArni_cD.V E ir3 Date 9 / i /
Permit Issued Date Isuéd /-(6/,(7
Signature of Administrative Authority S
Work Inspected by:. Permit Completion Date: I I
Inspector's Signature
Comments:
Note: Driveway approach must be constructed per City of La Quinta Standard 0221
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