2005, 12-07 Permit App: 06000015 Ramp) two I
i or Permit Center
11707 E Sprague AveSuite 106
40000 Valle Spokane Valley, WA. 99206
.7 (509)688-0036 FAX: (509)688-0037
Community Development www.spokanevalley.org.corn
Residential Construction
Permit Application
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w Construction ❑ cessory Bldg
❑ Addition/Remodel L Deck
❑ Other:
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SITE ADDRESS 1 1 1 1 £ (3o C ,rZ
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ASSESSORS PARCEL NO: 5 L " J, LEGAL DE R TION: t1L7 C? rirt4 1 try+) C �L —5
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Name: 1l 4/4itNN.Iv
Address: t'! / 91/ 5 `B& ciLev A'
City:. c.tJ Zip: ggaot7X
Phone: ""G/ " Cj a(3.
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Name:
Phone:
Describe the, scope of work in detail:
Cost of Project:
**************The following MUST be complete: (write N/A if not applicable)**********************
DIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
Name: Qy &(—
5 I iad
Address: PO '&J � 1( 3
FLOOR SQ. G:
City: Ill V 1k/t ciij
EN QZip:
C7ciDc c
Phone: LH --1401,?-
Fax:
DECK/COV C) - _G:
Lic No:
Exp. Date:
TYPE:
City Business Lic No:
S"le► ' •R SEPTIC?
Cost of Project:
**************The following MUST be complete: (write N/A if not applicable)**********************
DIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
TOTAL HABITABLE SPACE:
MAIN FLOOR TO S .
FTG:
FLOOR SQ. G:
UNFIN BASEMENT >;'IMPERVIOUS
SURFACE
AREA:
FINISHED BASEMENT
SQ. FTG:
GARAGE SQ. FTG. .------
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DECK/COV C) - _G:
30% SLOPES ON
-.,' g ' TY:
# OF BEDROOMS:„J_,G01VS`-TRUCTION
TYPE:
HEAT SOURCE:
S"le► ' •R SEPTIC?
The permitee verifies, acknowledges and agrees by their signature that 1) If this permit is for construction of 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 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) This City of Spokane Valley Permit is not a permit or approval for any violation of federal, state or
local laws, codes or ordinances. 6) Plans or additional information may be required to be submitted, and subsequently approved before
--this--applie
ir
Signature Crrl1 it
Date
Method of Pa ment: (Faxed permit applications will only be accepted with major bankcard)
0 Cash 0 Check 0 Mastercard 0 VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 5125/2005
MI 7)05
0 Other