2016, 02-16 Permit App: BLD-2016-0304 ResidentialjMe1.....::!:.::
. iolo-111.
Spokane Valley, WA 99206
Tel: (509) 720-2540
Fax: (509) 688-0037
perm itcenter0spoka neva Ileo. ora
R-E-SIDENTIAL CONSTRUCTION- PERMIT APPLICATION
NEW CONSTRUCTION ❑ ADDITION/REMODEL ❑ ACCESSORY BUILDING
❑ DECK ❑ OTHER
SITE ADDRESS: - ,
ASSESSORS PARCEL NO.: $S'0-%2 .2,3C I LEGAL DESCRIPTION
BUILDING.OWNER NAME-
NAME:H° !: c,4e ', N ov\t_5 Q
ADDRESS: 7_46� I'u
CITY: {•d M oT.J STATE: O . ZIP • 17
PHONE: V� I `� J- �7( -7 FAX: CELL:
CONTACT NAME:"
�YLa2 Cr-fRIS Ton�1FR$prl/ .
PHONE: FAX: CELL:
CONTRACTOR NAME: S c� rvq_ C15—Above—
MAILING
1sAbove—
MAILING ADDRESS:
CITY: 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:
****YOU MUST COMPLETE THE FOLLOWING****
_N./A..rF.._NO_T__APpLI.CABlf.............
Height to Peak:
_.
Dimensions:
--. _ ..
No..of Stories; ..
...... S.
Total,: -Habitable
, n
S ace: 40S
Main Floor SQ FT:
Upper loor SQ FT:
'Unfinished Basemen SQ
Finished .ement SQ
FT:
FT: pr
Garage SQ FT:
Deck/Covered Patio SQ
Impervious Surface
30% Slopes on
�S
FT: N PArea:
N*
Property: NA
No. of Bedrooms:
Construction Type:
Heat Source:
Sewer or Septic:
...._........--- ------ ------
TOTAL COST OF PROJECT: $ 1000
DISCLAIMER
The .permitted verifies, acknowledges and agrees by their signature that: 1) If thlS.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 Qty -of j
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 i
information may be required to 'be submitted and subseouently approved before this application Can be. processed.
_I
Signature
l
Updated 1-11-11 _
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