2012, 11-21 Permit App: BLD-2012-2135 MHSpokane
Va11ey
Community Develdpment Department
(permit Center
1703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter@spoka neva) lev.orq
(Staff Use Only)
ERMIT NUMBER:
PERMIT FEE:
(d -/ZZ/ I;
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
NEW CONSTRUCTION
0 DECK
0 ADDITION/REMODEL ACCESSORY BUILDING
0 OTHER
SITE ADDRESS: 1:6e -6 L i J ,9 6 rz /71/D -. 5p
ASSESSORS PARCEL NO.: s-S/q/ /p'% LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME:
ADDRESS: / / q /67; pk4
CITY: 6 -4_ .
IProjee ==tel �fG-
{
PHONE: 507- 7l - 4// FAX:
CONTACT NAME: ate, ai . j.s c' J
LE
STATE: — ZIP: V.7?-'/.
PHONE: aacj- / (-/ FAX:
CONTRACTOR NAME: R 9,
MAILING ADDRESS: p
CITY: 4st
1�. 2 2017
SV PERMIT CE_N I ER
SUL; #
r-TcELLT
3 Y/67
PHONE: 5 7 - ? c —�, 3 / /
CONTRACTOR LICENSE No.:
FAX:
STATE: ZIP: /5'3 5 —
CELL:APY
CITY BUSINESS LICENSE NO.:
EXPIRES:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE & PROPOSED USE:
A) 1 /
****YOU MUST COMPLETE THE FOLLOWING****
MARK N/A IF NOT APPLICAB
Height to Peak:
/7
Dimensions:
No. of Stories:,Total
Habitable
Space: / 3,esD
Main Floor SQ FT:
/3D0
Upper Floor SQ FT:
/777-
Unfinished Basement SQ
FT: 4')?-
Finished Basement SQ
FT: �/}'
Garage SQ FT:
37 ‘•-
Deck/Covered Patio SQ
FT: , ZO
Impervious Surface
Area:
30% Slopes on
Property: 7�
No. of Bedrooms: 3
Construction Type:
Heat Source: 64 5
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 to be submitted and subsequently approved before this application can be processed.
Signature gy¢ 1
Date: // -- /S /�-
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