2012, 01-03 Permit App: BLD-2012-2295 AdditionSpokane
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Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
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RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
❑ NEW CONSTRUCTION M ADDITION/REMODEL ❑ ACCESSORY BUILDING
❑ OTHER
❑ DECK
SITE ADDRESS: /3S ).2 E COY'
ASSESSORS PARCEL NO.: 1-/So3 /. 36o f LEGAL DESCRIPTION:
BUILDING OWNER NAME: 10 -J -rRo v D
NAME:
ADDRESS:
/11,2 S M12'6ot-a Cr
CITY: 51ofc NC VaC<f9v
PHONE: -Si) / 6 88 -
STATE: t...1 zIP: 99037
FAX: CELL:
CONTACT NAME:
PHONE:
FAX: CELL:
CONTRACTOR NAME: 7j
MAILING ADDRESS:
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:
r'a�D VG- (� 3 9 ti 1- N 3� 52 n-sa'.
****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: $
pISCLAIMER
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.
Effective October 28, 2007 Page 1 of 2
P:\Community Development\02 Administration \03 Forms - Official Versions\Permit Center\Residential Construction Permit
App 10.28.07.doc
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