2012, 10-26 Permit App: BLD-2012-1936 RemodelCITY OF
4••.Valley
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter@ spokanevallev.orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
❑ NEW CONSTRUCTION K ADDITION/REMODEL 0 ACCESSORY BUILDING
0 DECK ''1 ❑ OTHER
.
SITE ADDRESS: 4 k�/y�. 11 �Q SS'A['C
C- , 1�nme... enaka
ASSESSORS PARCEL NO.: 14511d. t' I LEGAL DESCRIPTIO:'1 es; &on A- ej.
BUILDING OWNER NAME: [ i) M It i GcI.Q Cptr i (JJO riCIMQ rr
NAME: LAY.,`1 ckYfN Yn_. . , Jcc
ADDRESS: ,11 { M � Ynacci t
CITY <_.. °Ake J STATE: W J
Fax:
PHONE: L
S9O—'7S6c•n
CONTACT NAME: � 1
CELL:
ZIP: qq2a.
sale_
PHONE: c -590 -17.50
FAX:
CONTRACTOR NAME: (
CELL: 50q - lO •')Scty
MAILING ADDRESS:
Cm:
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:
zc.,.m.,coom inn s';t- < ve `'rtCf . 'Zu; l e;lq tock%.
>>r,S1\:1n vu,m1-r, n cl.tn�, SFX- cue$ Some ele[.-Yeo\
****YODUST COMPLETE THE FOLLOWING****
MARK N/A IF NOT APPLICABLE
Height to Peak: /Y
/�/A,
Dimensions:/)
/�
No. of Stories: 1
Total Habitable
Space: 2.77G
Main Floor SQ Ff.
`ry �f
Upper Flo %Q r:
Unfinished Basement SQ
FT: / cS �i
Finish > sement SQ
FT: /
Garage �,t�l
Deck/Cove ed Patio SQ
FT: Deck/Cove
Impervious dace
Area: 4/
30% Slopes on
Property:
No. of Bedrooms: 3
Construction Type:Vat
Ie
Heat Source: G 4 S
Sewer or Se ic: 5 f U. i
TOTAL COST OF PROJECT: $ ,. 00
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 rev ttep'Petmtt cer L ,. 5)' The City of
Spokane Valley permit is not a permit or approval for any violation of federa , state or local law co or ordi ces. 6) 1 ans or additional
information may be required to be submitted and subsequently approved befr'ri6 tpGt ttF "` cp
r CRECEIVED
Effective October 28, 2007 Page
P:\Community Development\02 Administration\03 Forms - Officia Versions\Permirf'tei�i si2Mt�al Construction P
UtiApp 10.28.07 doc
CSV PERMIT CENTER
SUB # _LI REV #I
Loft
.rmit
Signature
Date:
Method of payment: 0 Cash 0 Check 0 Visa 0 Mastercard
Bankcard #: EXP: VIN#:
Authorized Signature: Watee tA)Oti62 e /V-- Z6,—/
F. ffective October 28. 2007 Page 2 of 2
P:\Community Development\02 Administration\03 Forms - Official Versions\Permit Center\Residential Construction Permit
App 10.28.07.doc