2013, 06-20 Permit App: BLD-13-1162 ResidenceCommunity Development Department
Permit Center
11703 East Sprague Avenue, Suite B -3
Spokane Valley, WA 99206
Tel: (509) 688 -0036
Fax: (509) 688 -0037
pe rm itcenteraspoka neva I ley. o rq
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PERMIT kJ'tfBKR6 2013
PERMIT FEE:
CC 71v1IT CCt,lTER
SUB # REV.# L- -_
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
NEW CONSTRUCTION ❑ ADDITION /REMODEL ❑ ACCESSORY BUILDING
❑ DECK ❑ OTHER
SITE ADDRESS: ---> —"> ( 7I%-C1 f u
ASSESSORS PARCEL NO.: 43-f2y. 03 O LEGAL DESCRIPTION: f SAP '"g
BUILDING OWNER NAME: i /dA � y/ jL) �&1 i . 19.13" f Lv+
ll�r!
NAME: ,`.� 1/1 /, AovlQ4
ADDRESS�I 0 . 14 t3G
Crr�r:
PHONE: (-OI)92 -4 - 1443-4
CONTACT NAME: kU(..Lajdzs
PHONE:'() -(437
CONTRACTOR NAME:
STATE:
LAJA
FAX: 6704) 22'1 -
FAx6 -64) q 2 L - G(oc
' ri 1
ZIP: 9/2 I/
CELL: 62,) 91 - 55'( r'
CELL: 60/) / ( -15-(
MAILING ADDRESS:'
C .
CITY: `)c)0\44 VGA-PA
PHONE: 6 �) 92-4 - 143-3- 1`
i3o
STATE: w \
FAX: \ ) z - <-160L,4
CONTRACTOR LICENSE No.: KACZKH H-I9 KEXPIRES: 3-3 ( - (4(
/ ZIP: lot 22 i .
CELL? "-c ) (Cl - 7 7
CITY BUSINESS LICENSE NO.: I (2.0S'(.04, ' 3,(s
DES IBE THE,S�OPPE OF WORK IN DETAIL AND INDICATE USE & PROPOSED USE:
��� '�_�
* ** *YOU MUST COMPLETE THE FOLLOWING * * **
MARK N/A IF NOT APPLICABLE
Height to Peak: / ,�
�. 2 ' `I"q
Dimensions: //
36 )� 4/11
/ ! No. of Stories: �)
-2 /
s Total Habitable
; Space: D2 4" /3
I Finished Basement SQ
1 FT: &OO
Main Floor SQ FT:
`i
Upper Floor SQ FT:
9-(o (o
Unfinished Basement SQ
FT:
Garage SQ FT:
.1/51
Deck /Covered Patio SQ
FT:
Impervious Surfac
Area: 1,2)z
1 30% Slopes on
Property:
No. of Bedrooms:
-
Construction Type: S'
Heat Source: 5
«'mss' Septic:
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 dwelling is /will
be served by potable water. 2) Ownership of this City of Spokane Valley permit inure to the property owner. 3) The signatory is the property
owner or has permission to repres t the property owner in this transaction. 4) All construction is to be done in full compliance with the City of
Spokane Valley Development cod
Spokan- Valley penni is not a per
mation nay be r irk{ to be
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
mitted and subsequently approved before tfjs application can be processed.
Effe ive October 28, 2007 � / Page 1 of 2
P: \Community Development \02 Administration \03 Forms - Official Versions \Permit Center \Residential Construction Permit
App 10.28.07.doc