2012, 08-03 Permit App: BLD-2012-1250 Pole BldgpoKane
,,;00Va11ey 1
Community Development Department
emit Center
703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
oermitcenter(cbsookaneva Iley. org ;
(Staff Use Only)
RMIT NUMBER:
PERMIT FEE•
i
r
r o j e c t #L --L7, -j2- J9)
RESIDENTIAL CONSTRUCTION PERMIT A L,F,fA Y fd-N
Ell NEW CONSTRUCTION
Ej DECK
SITE ADDRESS: E. //S/
0 ADDITION/ REMODEL!
0 OTHER 1
s== ACCAE000OFI(U%LDING
CSV PERMIT CEii ER
ASSESSORS PARCEL NO.: Z7, C)4/S-. LEGAL DESCR,1PTIO.N:
BUILDING OWNER NAME:
NAME: 1,17V
o
ADDRESS: ,,n 121 q
CITY: SGS ���—tom STATE: Z--L11kY- ZIP:
PHONE: FAX: CELL:
CONTACT NAME:
NE: FAX: CELL:
CONTRACTOR NAME: ; -,,-Y1 CC9,c/ (t'YI %�f9a> l!//y . ///I (J
MAILING ADDRESS:( �C
CITY: STATE: Zle�hl ZIP: �1�062
PHONE:. a%— FAX: 0/ Q2y,1 02ff7CELL: p�
CONTRACTOR.LICENSENO.:, �j /��� /�:4�jyJ(�'PXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF„WORK IN DETAIL ANDJNDICATE USE & PROPOSED USE:
****YOU MUST COMPLETE THE FOLLOWING****
MARK N/A IF NOT APPLICABLE
Height to Peak:
Dimensions:
No. of Stories: Total Habitable
(321VL
/
Space
Main Floor SQ FT:
Upper Floor SQ FT:
Unfinished Basement SQ Finished Basement SQ
FT: FT:
Garage SQ FT:
Deck/Covered Patio SQ.
Impervious Surface 30% Slopes on
FT:
Area: Property:
No. of Bedrooms:
Construction Type:
Heat Source: Q Sewer o Septic:
TOTAL COST OF PROJECT: $ L.1 i (9 3A
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 Valleymit is not a p rmit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information mayl bee to bAsubmitted and subsequently approved before this application can be processed.
nature ` kjAA- �-- Date: � '.5—
Updated
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Updated 1-11-11 Page 1 of 1
http: //www. spoka neva l ley.org/fi lestorage/124/938/210/948/ 1496/Bui Id ing_Permit_-_Residential_11-11-11.doc
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PLANNING DEPT. APPROVED
BY' APA -77,a,"
DATE.