2011, 09-09 Permit App: 11002795 Remodel BathroomSj�kane
�Valleya
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
perm itcenter@spokaneval ley.ord
(Staff Use Only)
PERMIT NUM R:
PERMIT FEE:
U NEW CONSTRUCTION
0 DECK
SITE ADDRESS: \ `�.1.(o
ASSESSORS PARCEL NO.:
Ig/ADDITION/REMODEL f] ACCESSORY BUILDING
0 OTHER
A -Na_
LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME:
ADDRESS: ' L (.0 6, 2- L" Pc qc
CITY:
PHONE:
\r
TA -TA- i Lo maS
PHONE: /� 1 Z I Z� l Q 5(L •
CONTRACTOR NAME: O j kI 2 -
STATE:
FAX:
CELL:
CONTACT NAME:
MAILING ADDRESS:
ZIP: l c
-V1-
(51C - L1 -c
FAX: CELL:
CITY:
STATE: ZIP:.
PHONE:
FAX: CELL:
CONTRACTOR LICENSE No.: •
EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE TIE SCOPE OF WORK IN DETAIL AND INDICATE
USE PROPOSED USE:
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****YOU MUST COMPLETE THE FOLLOWING****
N/A IF NOT APPLICABLE
Height to Peak:
Dimensions:
.'1 1( <K' is"
No. of Stories:
..'', 2
Total Habitable
Space: �12_1' 0
Main Floor SQ FT:
Upper Floor SQ FT:
Unfinished Basement SQ
FT:
Finished Basement SQ
FT:
Garage SQ FT:
Deck/Covered Patio SQ
FT:
Impervious Surface
Area:
30% Slopes on
Property:
No. of Bedrooms:
Construction Type:
Heat Source:
Sewer or Septic:
TOTAL COST OF PROJECT: $
$-2_`G)(7E�
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 represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of
Spokane Valley Dev-lopment code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley per i, is not a permit • approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may b= re .uired to be sub -d and subsequently approved before this application can be processed.
Signature -416. Date: � y 1 l
Updated 1-11-11 Page 1 of 1
http://www.spokaneva Iley.org/filestorage/124/938/210/948/1496/Building_Permit_-_Residential_11-11-11.doc