2010, 09-21 Permit App: 10002980 Remodelg z0�.
Spokane
valley
Community Development
rermtr Lerner
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509 688-0037
www. spokaneva11i
Residential Construction
Permit Application
PERMIT NUMBER:
PERMIT FEE:
New Construction
Addition/Remodel
Other:
Accessory Bldg
Deck
SITE ADDRESS:
i�1 N U12.A 0-49
ASSESSORS PARCEL NO: CJ JO14 7 1 O3 3 LEGAL DESCRIPTION: 6l?,tG1-+/ICZZ;ES I II✓14. lisr Q Si45{r-
4- N ..135 -.40t --
Building Owner: Kum PA7z, <
DIMENSIONS:
0 / k-
# OF STORIES:
to/ A---
Name:
vle..14t..i -:m
TO SQ.
Address:
Address: tca I b
N i2 IZ. "ArAz
City:
State:
City:p0,1
- Vpciv -y State:
ZipC'
y4
Phone: 5C1
44c 0e0 3 Fax:
# OF BED ODMS:
City Business Lic. No:
Contact Person
Name: V tr i
Phone: 1
Contractor:
DIMENSIONS:
0 / k-
# OF STORIES:
to/ A---
Name:
MAIN FL
FTG:
TO SQ.
Address:
FTG:
/
UNFIN BA EMENT SQ. FTG:
City:
State:
Zip:
Phone:
Fax:
DECK/COV.
Contractor Lic No:
Exp Date:
# OF BED ODMS:
City Business Lic. No:
TYPE:
HEAT SO)CE:
Describe the scope of work in detail: Cost of Project: $ 400
1J o 41 ,&%wti-ctlLa—
Proposed Use: J
**************The following MUST be complete: (write N/A if not applicable)**********************
HEIGHT TQ PEAK:
kic(/4-
DIMENSIONS:
0 / k-
# OF STORIES:
to/ A---
TOTAL HABITABLE SPACE:
N 1 %-
MAIN FL
FTG:
TO SQ.
2"D FLOOF'SQ.
FTG:
/
UNFIN BA EMENT SQ. FTG:
IMPERVIOU SURFACE
AREA:
FINISHE
SQ. FTG:
BASEMENT
GARAGE
SQ. FTG:
DECK/COV.
PATIO SQ. FTG:
30% SLO ES ON
PROPER :
# OF BED ODMS:
CONSTRUCTION
TYPE:
HEAT SO)CE:
SEWER O SEPTIC?
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of 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) This 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:
Method of Payment:
❑ Cash
Bankcard #:
Authorized Signature:
REVISED 2115/07
❑ Check
2*LDATE: 021.
❑ Mastercard
Expires:
❑ VISA
VIN#:
(1_6/0