2013, 01-16 Permit App: BLD-2013-0062 Remodel�ommunity Development Department
c- ermit Center
crrYof 11703 East Sprague Avenue, Suite 8-3
Sp®kan^ Spokanel: W 99206
G Tel: (509) 688-0036
Tal le��, Fax: (509) 688-0037
�•/ Fax: (center 8-003 neva1Iey.orq
(Staff Use Only)
ERMIT NUMBER:
PERMIT FEE:
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
® NEW CONSTRUCTIONti>(iADDITION/REMODEL ] ACCESSORY BUILDING
I] DECK I] OTHER
SITE ADDRESS: t\3\0 € e 021-%G.K._
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION: z l
BUILDING OWNER NAME: 1 Project _ Ott- 24/3'-D0,6%
fCVCJVCL)
NAME:
ADDRESS:
Cm:
PHONE:
JAN 1 6 2013
STATE: )
FAX:
CONTACT NAME:
roti
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. KEEL:--
v� r`CV. I I I
PHONE:
FAX: CELL:
CONTRACTOR NAME: a.--a.Lt-t` nS LL
MAILING ADDRESS:
CITY:
STATE: ZIP:,
PHONE:
FAX: CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE & PROPOSED USE:
6.#r/ieeoIi'1 .(t eso — tee mOU& Q . pt l-nE sifter te.e z Act/al-770N NEW
Eft/pH/Sr f// -A/
****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 Floor SQ FT:
Unfinished Basement SQ
FT:,
Finished Basement SQ
FT:
Garage SQ FT:
Deck/Covered Patio SQ
FT:
Impervious Surface
Area:
30% Slopes on
Property:
No. of Bedrooms:
Construction Type:
Heat Source:
Sewer or 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 t• be Submitted roved before this application can be processed.
Date: lb 13
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