2013, 01-02 Permit App: BLD-2012-2019 Residence.0/
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B -3
Spokane Valley, WA 99206
Tel: (509) 688 -0036
Fax: (509) 688 -0037
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RECEIVED
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
El ACCESSORY BUILDING
O NEW CONSTRUCTION • ADDITIONOTHER /REMODEL
SITE ADDRESS: ! 4 a IWQ 1.014
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION: [ or
BUILDING OWNER NAME:
NAME: k4 L. tit' t & V
ADDRESS: D 14:1hil4BWr"r *100
STATE: k A
FAX: 1= 0 Vic
CONTACT NAME: '> 1,40/
PHONE: ` / / FAX:1 4li ' 2t
CONTRACTOR NAME: "441....' -}' ��[. Lj ILL• &"
cm: I>u ,t-r
PHONE: 52i ti q z 3
MAILING ADDRESS: •I Q " N L U IV.IV fepe,ft...re 1o;
CELL:
ZIP: tc1 �<7
‘-- 91 -7978
CELL:
- 7/7/
7/
CITY: Ai/ 4r. .. %C� rAt STATE: t_Q•� ZIP:
��,— - / ,,, FAX: Z-* Ql' 4;1
CONTRACTOR LICENSE No.: L411,44 ett 1_140 EXPIRES: iii, ,014 CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WQ& hLDAND,INDUGrt7i PROPOSED USE:
PHONE:
CELL:
* ** *YOU MUST COMPLETE THE FOLLOWING * * **
Height to ex'ic/
Dimesslops I
��1;�C %
No. of Stories:
Total Habitip1 �n
Space: /JCS c3F
per ��� �T�
i
Unfinished Basement SQ
FT: r'..
Finished casement SQ
FT: ---.
MalnF rS�iFjN
Garage SQ FT•
4
�
Deck /COV o
FT: 10
Construction . :A d✓ /
Impervious Surface
Area: ....---...Q,
Heat Source:
30% Slopes on
Property;
...
Se 'c:
No. of Bedrooms: �
TOTAL COST OF PROJECT: $
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction or on a dwelling, the dweelllingisfwili
be served by potable water. 2) Ownership of this City of Spokane Valley permit inure to the property owner. 3) The signatory_ property
perty
owner or has permission to represent the property owner in this transaction. 4) All construction is to be done In full compliance with the City of
Spokane Valley Development code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit is not a permit' .r approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
Information may • .uired o • - ,miffed and subsequently approved before this application can be processed.
W.W,t17 '' / z E /
E e October 28, 20.7 Page 1 of 2
P: \Community Development\02 Administration \03 Forms - Official Versions \Permit Center \Residential Construction Permit
App 10.28.07.doc
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