2012, 04-23 Permit App: BLD-2012-0456 Residence h le
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Permit Center
Spokane 11707 E Sprague Ave, Suite 1t ITY OF SPOKANE VALLEY PERMIT NUMBER:
Spokane Valley,WA 99206 APR2012
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(509)688-0036 FAX: (509)688-0037 3 PERMIT FEE:
Community Development www.spokanevallev.org.com FtE TER
BY:
DIM
Residential Construction Er Nevi struction n Accessory Bldg
Permit Application ❑ Addition/Remodel El Deck
❑ Other:
SITE ADDRESS 20 b 4 N.I. C/00.0(1
ASSESSORS PARCEL NO:Ss033. 2,1 LI LEGAL DESCRIPTION: c116 Va. Mad i W5 Lb V 141$I4-2
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Bu din �� � . T , . L . on raclor i.
Name: y
.. Name: a.
Address: Address: 7 (: ., ,i, _ ',' , i,,_.,.„/
City: Zip: City: Zip:
Phone: Fax: Phone: Fax:
Lic No: Exp.Date:
Con tact Person
' City Business Lic No:
Name: ;.-1, L,.,
Phone: r;A -L'vd
Describe the scope of work in detail: Cost of Project: $ co .,,,TM c_,
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**************The following MUST be complete: (write N/A if not applicable)**********************
HEIGHT TO PEAK: , DIMENSIONS: #OF STORIES: , TOTAL HABITABLE SPACE:
MAIN FLOOR TO SQ. 2ND FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: IMPERVIOUS SURFACE
FTG: / - 56V AREA: ,'v/A
FINISHED BASEMENT GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG: 30% SLOPES ON
SQ. FTG: ---, Li 'Y ` i 60 PROPERTY: it /AA.
#OF BEDROOMS: __,: CONSTRUCTION TYPE: HEAT SOURCE: f SEWER OR SEPTIC?
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DISCLAIMER
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 application can be processed.
Signature /1.1f,i1_ , . Date 1311051 ti-Z-5-/-1-
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Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature:
REVISED 6/25/2005
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