2012, 04-23 Permit App: BLD-2012-0455 ResidenceSix ne
r Valley
Community Development
rcl�ll ibPi
Pernut Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www.sookanevalIev.ori,.com
Residential Construction
Permit Application
zoiz- NYS
.;PERMIT NUMBER
a==PERMITl FEE
[thew Construction
o Addition/Remodel
o Other:
o Accessory Bldg
o Deck
SITE ADDRESS 100 1 S. r14 CA OAL (A
ASSESSORS PARCEL NO: `45224. 11 01 LEGAL DESCRIPTION:
EBuildtngiowper
HEIGHT TO PEAK: Z�I)
DIMENSIONS: 5C1#
-
Name: );ayno,1Lr
2-r
(OAS±•
Address:
IMPERVIOUS SURFACE
AREA:
FINISHED BASEMENT
City:
.
DECK/COVPATIO SQ. FTG:
100
Zip:
Phone:
Fax:
CONSTRUCTION TYPE:
S /= Z
fContact,Yersontir-
Name: Pact
Phone: z i SS- (./gall
Describe the scope of work in detail:
3ut Ids, s F2
,Yiawtt,. Plato Laf) sitz
r�_ontraetor�� =
Name: DiA3n8Ad ZOGC (ern /ts'/
Address: 2.60Z rt/, Su/I1✓C 4 IZCI
city: sibt..47/Le or' Zip: 997/6
Phone: CjZc!- J69 Fax: 926-Xo9L/
Lic No: Exp. Date:
City Business Lic No:
Cost of Project:
1 $ 7U, 000 I
**************The following MUST be complete• (write N/A i
•
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 applicatioj n be processed.
Signature
Date
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
0 Cash ❑ Check ❑ Mastercard 9 VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8252005
L( -z3 /Z
❑ Other
HEIGHT TO PEAK: Z�I)
DIMENSIONS: 5C1#
OF STORIES: i
I
TOTAL HABITABLE SPACE:
IP -II
MAIN FLOOR TO SQ.
FTG:
1414 I
2nD FLOOR SQ. FTG: _
-
UNFIN BASEMENT SQ. FTG:
IMPERVIOUS SURFACE
AREA:
FINISHED BASEMENT
GARAGE SQ. FTG:
Ike(
.
DECK/COVPATIO SQ. FTG:
100
30% SLOPES ON
SQ.
PROPERTY:
FTG: —
# OF BEDROOMS:
3
CONSTRUCTION TYPE:
S /= Z
HEAT SOURCE:
Alctturc.( Gas Pornc qq
SEWER OR SEPTIC?
Sttate✓
DISCLAIMER
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 applicatioj n be processed.
Signature
Date
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
0 Cash ❑ Check ❑ Mastercard 9 VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8252005
L( -z3 /Z
❑ Other
Scale /q 5�
Lv%I hl z
nnc.w�r- Pace
ll�ol S. mei mar ed
APPROVED
PLANNING DEPt'
Bt..
01\1E..
`772-3/ iv