2012, 03-28 Permit App: BLD-2012-0240 ResidenceSpokane �``�
'Valley
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
Fnevaliey org
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
P NEW CONSTRUCTION ❑ ADDITION/REMODEL
❑ DECK j 0 OTHER
SITE ADDRESS: 2 ,(_ I
ASSESSORS PARCEL NO.: 1-432.`2,2. 1 Y-.) LEGAL DESCRIPTION:
BUILDING OWNER NAME:
0 ACCESSORY BUILDING
Loy e 1 1GK.
NAME: \ 7T L \. kv\l rlZ i l / U /r.l, 0\1 l
ADDRESS: 1 t�.I . t .-A L
CITY: STATE: WA ZIP: 9 9 Z. .'
PHONE: if r )) (15)- I) 03 FAX: i 3L! ) 1 I I O CELL: (`fit t) 65/ ` 19 d z
CONTACT NAME: ,. -60
PHONE: ? i --)9 0 5 FAX:( y)3 T 9 11 CELL: (50.c) Ci J f Ic o s
CONTRACTOR NAME:
MAILING ADDRESS:
CITY:
STATE:
Zip:
PHONE:
FAX:
CONTRACTOR LICENSE No.: 577A0 c log L EXPIRES: t` /I) CITY BUSINESS LICENS
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE & PROPOSEDUSE: �C
('rAv-,oz.oe 7 704 F I /1.1 a L T t t.y a-tt -t ,.���,I,.t,�:.�_
CELL:
EN FER
a, e
4412
****YOU MUST COMPLETE THE FOLLOWING****
T APPLICABLE
Height to Peak:
Dimensions:
1.
No. of Stories:
Total Habitable (�
Space: 1 L 11� 't'"+
Main Floor SQ FT: i_
I f 1�/ Y) c(
Upper Floor SQ FT:
"/ A
Unfinished Basement SQ
FT: NJ/\
Finished Basement SQ
FT: NI ,\
Garage SQ FT:
OK"—
Deck/ overed Patio SQ
FT: 3 b
Impervious Surface
Area: rj IA
300/0 Slopes on
Property: J� I A
No. of Bedrooms:
Construction . w2,ft
I(feat Source: f ( CGA'
Sewer or Septic: S tU"C-e.....
TOTAL COST OF PROJECT: $ I1-\ 01
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) 0 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 Development code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The 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.
Effective 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
Signature
Method of payment: 0 Cash
.x i A i)-)+1 l i1 Is, ! t � Date: /t'10 itZ i 2-)/ Z,
0 Check 0 Visa 0 Mastercard
EXP: VIN#:
Bankcard #:
Authorized Signature:
Effective October 28, 2007 Page 2 of 2
P:\Community Development\02 Administration\03 Forms - Official Versions\Permit Center\Residential Construction Permit
App 10.28.07.doc
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