2006, 12-01 Permit App: 06004710 ResidePermit Center
orakai�e 11707 E Sprague Ave, Suite 106
.0,00Valley
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development www.spokanevalley.org.com
Residential Construction
Permit Application
PERMIT NUMBER: Y---7/
PERMIT FEE:
o New Construction o Accessory Bldg
.lddition/Remodel o Deck
o Other:
SITE ADDRESS 1171 . 4/ (/V h✓t-
ASSESSORS PARCEL NO:
o�� Val/r,77/.6
LEGAL DESCRIPTION:
Building owner
Name: D --,.,,A.,,„ VJ 1^o 9
Address: y 9/G (i/ ✓;,—
City: l'pd Au.✓r ,c-- ZiP: 9' Z/(
Phone: 9.42 /('fax:
Contact Person
Name: Ck � 14&l!
Phone: 9�c� /5
Describe the scope of work in detail:
Contractor :..
Name: (i- /14 , S t 4e
Address: 77 / S! , • 1»-,- (7,27
City: cipi, I\/` -1/ Zip: %92../
Phone: 9Z 2.— 9V V/ Fax:
Lic No: GHS rid V4 p. Date:
City Business Lic No:
Cost of Project:
**************The followin MUST be complete: (write N/A if not applicable)**********************
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
TOTAL HABITABLE SPACE:
MAIN FLOOR TO SQ.
FTG:
2Nu FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
IMPERVIOUS SURFACE
AREA:
FINISHED BASEMENT
SQ. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
30% SLOPES ON
PROPERTY:
# OF BEDROOMS:
CONSTRUCTION TYPE:
HEAT SOURCE:
SEWER OR SEPTIC?
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 applicatione processed.
Signature'
Date
Method of Payment: (Faxed peapplications will only be accepted with major bankcard)
0 Cash Check 0 Mastercard 0 VISA
Bankcard #: Expires: VIN#:
0 Other
Authorized Signature:
REVISED 8/25/2005