2012, 10-04 Permit App: BLD-2012-1745 Pole BldgSpokane
Walley°
Community Development Department
hermit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
perm itcenterColspoka nevalley.orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
Project #_!Moj'IZ- 174C
RECEiVED
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
114 7017
a NEW CONSTRUCTION 0 ADDITION/REMODEL 0 ACCESSOnrT RY BUILDING
Q DECK El OTHER
SITE ADDRESS:
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ASSESSORS PARCEL NO.: S/5333, //O LEGAL DESCRIPT?ONe
PERMIT CENTER
REV. # 1 1
BUILDING OWNER NAME:
S , 1
NAME: -46V"fes/ KC C�j�Cs5/� (f7 iC l��VtQ
ADDRESS: 4/2-7.1 S. l (,/ o not")<L 1
CITY: S9C) f nk r'[� (+/rp(( Y// STATE: £/LJ /-
PHONE: .SQS_c(_Z.S—Z% tThEAX: CELL:
CONTACT NAME: r—S
ZIP:
PHONE:
FAX: CELL:
CONTRACTOR NAME: f-,ZAnijcc,
22/- 7/Z Jr�lCfc rPS'
MAILING ADDRESS:
��. 130 1(s3
CITY:
PHONE:
(lc -t r-1 /[.f r-/
-c --
?c91- 4033
FAX:
STATE:
LAJ _
CELL:
ZIP:
CONTRACTOR LICENSE No.:
A/fvs 43yeVPIRES:
CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE & PROPOSED USE:
30X5DYfX/6 ,QV S7a(A9S
****YOU MUST COMPLETE THE FOLLOWING****
MARK N/A IF NOT APPLICABLE
Height to Peak:Dimensions:
2/ /
30 X 4Space:
No. of Stories: a
Total Habitable
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:
300/0 Slopes on
17:rrty:
No. of Bedrooms:
Construction Type:
Heat Source:
ewer 94 Septic:
aZMerfp �f' �T S r73
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) Tne signatory i5 the property
owner or has permission to represent the property owner in this transaction. 4) All construction i5 to be done In full compliance with the City of
Spokane Valley Development code. R c 5 are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit is not a •- i or approval any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
Information may be requir-: o be/sub/`� :.ueotly approved before this application can be processed.
Signature Date: 6 -
TOTAL COST OF PROJECT: $
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
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