2012, 03-28 Permit App: BLD-2012-0290 Remodel Permit Center
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'' 11703 E Sprague Ave,Suite B-3 PERMIT NUMBER: --� Z e7 b
�"�"°F� i" Spokane Valley,WA 99206 l� Z
PERMIT FEE:`��.L : 2_s--
Valley (509)688-0036 FAX:(509)688-0037
4000 11 www.spokanevalley.org L. i
C :winuni y >t:;veiopi��eift CITY OF j&SPOKANE VALLEY
Rero4 Constructionn Commercial
PERMIT CENTER
Permit Application BY: Residential
SITE ADDRESS: :2_57jo 3(:), g j c d Nb (A��L.E--
ASSESSORS PARCEL NO:
Building Owner: Contractor: CO vi N(el T ON Ct0rv`.5m.�Lv N
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Name: C. 1.'1 w I i:40 L c Name. �AN / 7y )b' 71-( '64,1 3
Address_ 170Ave-i 7 TI-�" AVAddress: 1, 2,1_1, LA 6.ie.T1,/ tav`G a, 4 Z Z#
City: '7; 'e0 N 1K_ State: A.-z_ Zip: 21 City: LI gi.-82-r1 Lilt/4_ State: w Zip:X101
Phone: Fax: Phone:5- oct,get 1• DOS(, Fax: 509-?c 1, S /
Contractor Lic No: Exp Date:
Contact Person City Business Lic.No:
Name: .D/w/V ern_
Phone: rho -.7/1/• O!' / 3
Describe the scope of work in detail: ,Tear offOverlay
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Cost of p="-oject: et,ApP
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The permitce 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
processed.
Ownership „r res I ig develo ent rig is 2 ranteddb y issued permit inure to the property ow er.
Signature - 1 IA' �4..-- Date 3 Z'Le) ( Z-
Method of =ayment:
❑ Cash ri Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN#:
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Authorized Signature:
REVISED 8!23/2005 C
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