2012, 10-08 Permit App: BLD-2012-1769 RemodelCommunity Development Department
Permit Center
��'� 11703 East Sprague Avenue, Suite B-3
`��jiI�J
oe�pl�s��� Spokane Valley, WA 99206
�®Tel: (509) 688-0036
Valley. Fax: (509) 688-0037
�/ permitcenter@spokanevaliey.org
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
0 NEW CONSTRUCTION 0 ADDITION/REMODEL r`? ACCESSORY BUILDING
0 DECK % OTHER
SITE ADDRESS: / / 3 3 S
ASSESSORS PARCEL NO.: LEGAL DESCRIPJrION:
-"rig
BUILDING OWNER NAM oilE: a cla..c ruz c0
NAME: CL
ADDRESS:
CITY:
PHONE:
•
/ STATE:
FAX:
CELL:
zip: 910 Y 7
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:
Main Floor SQ FT:Upper
to
F
PHONE:
FAX:
Finished Ba ment SQ
FT:
Garage SQ
AIL/ q
PreFrOlgt # ar 2-4a - /76
CONTRACTOR NAME:
300/0 pes on
Prop rty:
No. of Bedrooms: ,'1
Construction Type:
RECEIVE ..
MAILING ADDRESS:
OCT 0 8 2012
CITU:.
STATE:
ZIP:
CSV F'tPIMIT CENTER
PHONE: -
FAX:
CONTRACTOR LICENSE No.:
EXPIRES:
CITY
Q�C�E�LL:
BI%jSS'}�
L r'rN(F N) • REV. # L�
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:
Main Floor SQ FT:Upper
to
F
Floor SQ FT:
Unfinished Baserpent SQ
FT: /2, ZS
Finished Ba ment SQ
FT:
Garage SQ
AIL/ q
Deck/Covered Patio SQ
FT: to
Impervious Surface
Area:
300/0 pes on
Prop rty:
No. of Bedrooms: ,'1
Construction Type:
Heat Source:
Sewer or Septic:
TOTAL COST OF PROJECT: $ NI 000
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
Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Building_Permit_ _Residential_11-11-11.doc