2005, 10-06 Permit App: 05003670 WindowsPermit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development www.spokanevalley.org.com
Residential Construction
Permit Application
PERMIT NUMBER: 3 (.. 0
PERMIT FEE: 73 -�
D New Construction o Accessory Bldg
o Addition/Remodel o Deck
vf Other: `z-cycz st)
SITE ADDRESS c1 a' 1 P ,.. y to C1 -)lat
ASSESSORS PARCEL NO: + J ' (1 V. LEGAL DESCRIPTION:
Building owner 1(1 itVW) i. -
e, I 1 t
Name: {(.�U.-i . Ke o YYizr ! Ca k GSC C
TOTAL HABITABLE SPACE:
Address: `l' )-i S, )CG. V k (2l(
* 1(''L'
City: .SFre 11 ave .‘"C I(e ij Zip: c/ t;l --
Zip:
P one: 3,)_F> -L)(v I S Fax:
Fax:
Contact Person
Name: V--€ VA Cv' Kt .L N ai ct ho FF
Phone: S (+`i C.,L 1'S
Contractor
DIMENSIONS:
Name:
TOTAL HABITABLE SPACE:
Address:
2N0 FLOOR SQ. FTG:
City:
Zip:
Phone:
Fax:
Lic No:
Exp. Date:
City Business Lic No:
CONSTRUCTION TYPE:
Describe the scope of work in detail: Cost of Project:
lac e I >h 1�( �+ocio r+ 1 ��c �;� l�>� �c 0,0 p IacQ,
1A.1. h L x •," ct .
49L('-).
**************The followin>; MUST be complete: (write N/A if not applicable)**********************
HEIGHT TO PEAK:
DIMENSIONS:
-
# OF STORIES:
TOTAL HABITABLE SPACE:
MAIN FLOOR TO SQ.
FTG:
2N0 FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
IMPERVIOUS SURFACE
AREA:
FINISHED BASEMENT
SQ. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
30% SLOPES ON
PROPERTY:
# OF BEDROOMS:
CONSTRUCTION TYPE:
HEAT SOURCE:
SEWER OR SEPTIC?
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 application can be proce
Signature "' '. Cay. i Date /6/624,
,.
Method of Payment: (Farermit app ' ations will only be accepted with major bankcard)
0 Cash heck 0 Mastercard 0 VISA
Bankcard #: Expires: VIN#:
0 Other
Authorized Signature:
REVISED 8/25/2005