2012, 03-20 Permit App: BLD-2012-0192 ResidenceSpokane
Valley%
Community Development Department
,rmit Center
_703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter@spokanevallev.orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
Et NEW CONSTRUCTION
❑ DECK
❑ ADDITION/REMODEL ❑ ACCESSORY BUILDING
❑ OTHER
SITE ADDRESS: 162 ( 5‘,
ASSESSORS PARCEL NO.:
BUILDING OWNER NAME:
LEGAL DESCRIPTION: 1 ; p ED
(SV PERMIT CENTER
NAME: f i v r-4 P S EN 002'N S
ADDRESS: 6C tap S ' e'"V- ( t
CITY: SF \/ Pc i_j_
STATE: ITS
MM 2
9'ro)ect> (el —1Z i+ L
Name_ to
Ju 1iTli(t. 1
PHONE: a - s s 4H; (O
CONTACT NAME:
FAx: 4t __St o�
CELL: 6,
PHONE:
FAX: 4 (
CELL:
CONTRACTOR NAME: �(� � , N NSI {.
MAILING ADDRESS: •7<' Y `�Z— ' 3 ? t9
CITY:
PHONE:
.63? ?4'S&•
CONTRACTOR LICENSE No.:
STATE: IA A
FAX: .4-t (�
EXPIRES:
CELL:
ZIP: 1 -1
g45
CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE & PROPOSED USE:
****YOU MUST COMPLETE THE FOLLOWING****
MARK N/A IF NOT APPLICABLE
Height to Peak:
Dimensions:
No. of Stories:
Total Habitable
Space:
Mai door 9, FT:Upper
����� t_ J(�
Floor SQ FT:
or_.�
Unfinished Basement SQ
FT:
Finished Basement SQ
FT:
Garage SQ FT:
/ r,db S F p
Deck/Covered Patio SQ
FT:n IL
Impervious Surface
Area:
30% Slopes on
Property:
No. of Bedrooms: -5
Construction Type:
Heat Source: 5
Sewer r Septic:
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
Date: g/2.,
Upd e -IPI 11-1 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Building_Permit_-_Residential_11-11-11.doc
•
RECEIVED
CSV PERMIT CENTER
MAR 2 0 2012.
Project # esigA-12--143//1Z1
Nam'a
15t2-1 is4,6(t2E14 1-1171,4
I'ct 7f;rp-vAeroz-
lot Ri N
th
LOT = '11)32 S
PLANNING DEPT. APPROVED
By:
3/2072.o/2_.
thF-1-111-{