2013, 12-10 Permit App: BLD-2013-2498 Gas TestSpokane
4,0•0Valley.
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter@spoka neva lley.orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
EJ NEW CONSTRUCTION D ADDITION/REMODEL E ACCESSORY BUILDING
Q DECK
SITE ADDRESS:
ASSESSORS PARCEL NO.:
OTHER
tA7-?)00-a(466
LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME:
ADDRESS:
,:SV PERMIT CENTER
CITY:
PHONE:
STATE: ZIP:
FAX: CELL:
CONTACT NAME:
PHONE:
�►\ vtA o4'
CONTRACTOR NAME:
ZS
FAX:
CELL:
MAILING ADDRESS:
/V,
CITY:
PHONE:
C c
STATE:
zIP: 3
05,7
FAX:
CELL: 2 c2
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 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 re ent the propert . ner in this transaction. 4) All construction is to be done in full compliance with the City of
Spokane Valley Developm cod Reference. co . -s re available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit I not a per it or appr. al f .y� vi ion of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be req ired to be bmitted . d b — uenjr approved before this application can be processed.
Signature
Date:
Om -
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