2015, 01-28 Permit App: BLD-2015-0160 AdditionSc'okane
p.
Valley
Community Development Department (Staff Use Only)
Permit Center
11703 East Sprague Avenue, Suite B-3 PERMIT NUMBER:
Spokane Valley, WA 99206
Tel: (509) 720-5240 PERMIT FEE:
Fax: (509) 688-0037
permitcenterCDaspokanevaIley. org
RESIDENTIAL CONSTRUCTION PERMIT_APPLICATIO
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0 NEW CONSTRUCTION 'ADDITION/REMODEL ] ACCO �l �r DMUG
E, DECK OTHER
SITE ADDRESS: I (ij Q S C U +J IAN 7 R ?MS
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION: V
OWNER/APPLICANT (CHECK BOX, IF MAIN CONTACT [ ): CSV PERMIT CENTER
REV. #
NAME: ���1�il/I/C+�"Y� � r�/. / `t—�Q�t�jy'�I i�� SUB # �J L_
ADDRESS: ( 62 10
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CITY: t li-R r�i STATE:;1'00/ ZIP:
PHONE:
FAX
EMAIL:
CONTACT NAME:j1,�7�;
PHONE: FAX: EMAIL:
CONTRACTOR NAME (CH, BOX, IF MAIN CONTACT A
H):�r-1'all, „
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: EMAIL:
CONTRACTOR LICENSE NO.: EXPIRES: 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 N0T APPLICABLE
Height to Peak:' r
( -?
Dimensions: i i
/02 x')- 8Space:
No. of Stories:
Total Habitable 33G
Main Floor SQ FT:.
Upper Floor SQ FT:
N
Unfinished Basement SQ
FT: /U i?-
Finished Basement SQ
FT: N
Garage SQ FT:,
Deck/Covered Patio SQ
FT: G�
Impervious Surface
Area:
30% Slopes on
Property:
No. of Bedrooms: p
1Construction Type: WLXD
Heat Source: j -e -T
1 Sewer or Septic: S
TOTAL COST OF PR03ECT: $
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.
Updated 12-1-14 Page 1 of 1
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PLANNING DEPT. APPi%,OVEE)
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