2015, 03-13 Permit App: BLD-2015-0490 Fenceewer or tic:
No. of Bedrooms: .CensitEruction Type: S Sep
TOTAL COST OF PROJECT: $ —�--_
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 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.
Signature.
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CITY (W
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Community Development Perprizyttntt # (Staff—Use-Only)
Permit Center tt33-y
4000.1\0144
11703 East Sprague Avenue, Suite 8-3R E C 6��iT NasER:
Spokane Valley, WA 99206
Tel: (509) 720-5240 p
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Fax: (509) 688-0037Vjlt"
4000 permitcenter(spokanevaIj y.org
CSV PERMIT CENTER
RESIDENTIAL CONSTRUCTIONPERMI1i APPIL CATI •
❑ NEW CONSTRUCTION ❑ ADDITION/REMODEL
❑ DECK 0 OTHER
SITE ADDRESS: / t/D % F , �Q,/ ki
❑ ACCESSORY BUILDING
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
OWNER/APPLICANT (CHECK BOX, IF MAIN CONTACT ®):
NAME: nom Neisa,u
ADDRESS: / Y 4-/D E, A 1 K)
CITY:
PHONE:
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So _c7)2 Pr p33
CONTACT NAME: 0a? A)
FAX:
STATE: (/)
ZIP: I /
EMAIL:,JeI.5a4 TR (Q.r'i-)s-r y ik
PHONE: S A AA *-R FAX: —
CONTRACTOR NAME (CHECK BOX, IF MAIN CONTACT E:1):
EMAIL:
MAILING ADDRESS:
CITY:
STATE: ZIP:
PHONE:
FAX: EMAIL:
CONTRACTOR LICENSE NO.:
EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK I DETAIL AND INDICATE USE PROPOSED USE:
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****YOU MUST COMPLETE THE FOLLOWING****
MARK N/A IF NOT APPLICABLE
HeightP,,,ak: " -
/cJ
MDimensions:
-
No. of Stories:
Total _aceHabitab
S
Main Floor SQ FT:
Upper Floor SQ FT:
Unfitnished Basem
FT: = :f-- .""'
Finished Basement SQ
FT:
Garage SQ FT:
Deck/Covered Patio SQ..
FT: , _----' "`*---
--pervious Surface
Area:
30% Slopes on
Property:
Heat Source:
1 .c2/`v-,, )4 -
Date: " l