2013, 02-27 Permit App: BLD-2013-0309 RemodelRes idential_Construction_Perm it_Application.pdf
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http://www. spokanevalley.org/filestorage/ 124/938/210/948/335/Keside..
Spokane
Valley
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
I ax: (509)688 003/
permitcenter@spokanevalley. orq
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
ADDITION/REMODEL ❑ ACCESSORY BUILDING
❑ OTHER
❑ NEW CONSTRUCTION
❑ DECK
SITE ADDRESS: i 0
ASSESSORS PARCEL NO.:
BUILDING OWNER NAME:
< c' `� 9031
��� ► cu,t, � �r p1`c���V��1le j vg Pt 1
157_33, I2 -c9 LEGAL DESCRIPTION: V( ;1/5 Hct vU--) pc()
1, B 1
NAMI: svCid Mu_(1G\,J f (\.n(iJVIL't6,1 .M• U&cCieV-A- .)
ADDRESS: CI 1 V • tz
CITY:
Pt1ONt :
('c,9') '711 L 1 E 5
STATE: ti/V
CONIACI NAMI: \cQ\ NiC.1.1C,V'ICl,i(1
PHONI :
` r r c _ er,
> t i 122 I
FAX:_. -NSA-
ZIP: 99 /L/l 2j'
CELL: 559 - `y `65c/5
FAX:
CONTRACTOR NAME: k1 1} „ (woY1fA 0,64 cruc5,e,jv >
CELL:
0091 /4 55,5
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:
h i (Y6In CC'1 r\ t% e Ca ‘(-)&1'- ) bk.,\ eft r G' v o- sl-ru Alxcut
c\t,fv6%'.ncv1/4) v,1/41% ,,tpzira,l nG\ 'into-c�rn•rttj room, °Cict%beCif o n,
****YOU MUST COMPLETE THE FOLLOWING**** St a - C1cSX,ts,/L-n4
MARK N/A IF NOT APPLICABLE ✓ A criai l i Cite. are4
Height to Peak: .1
;
Main 1100r SQ 1 1:
Garage SQ FT:
Nph
No. of Bedrooms: ji1 A
DImelisions: r No. of Stories: I `tr'T + n
•`i1 `
Unfinished Basement SQ
Upper f loor SQ 1 1:
Hirt
Deck/Covered Patio SQ
1 1:
/ pt.
Construction Type: -NAii;DD
FT:
(XL?
Impervious Surface
Area: N
Heat Source: Cl i
Total Habitable
Space:
Finished Basement SQ
FT:
Li 76
:30% Slopes on
Property: Ni
Sewer or Septic: SGN5
TOTAL COST OF PROJECT: $ 2, t4 CC' - O�PPY�1C
DISCLAIMER (tT( Wa11S I g\s\itcktibr+ld(t{ Wt. ,, dCL`YS / pante)
the permitted verifies, acknowledges and agrees try their signature that: 1) if this permit is for construction or or 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 aroperty owner in this transaction. 4) All construction s to be done in full compliance with the City of
Spokane Valley Development code. Referenced codes are available `or 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
information may be required to be subr^itted and subsequently approved before this app!icat+ori can be processed.
Effective October 28, 2007 Page 1 of 2
P:\Community Development\02 Administration\03 Forms - Official Versions\Permit Center\Residential Construction Permit
App 10.28.0/.doc
1 of 2 2/26/2013 8:32 PM
- Residential Construction Permit Application.pdf http://www.spokanevalley.org/tllestorage/1L4/9i /Z 1v/Y45/.1iJ/1Cesiue..
Signature
•
•
Date:
Method of payment: ❑ Cash ❑ Check
Bankcard #:
❑ Visa ❑ Mastercard
EXP:
VIN t :
Authorized Signature:
Effective October 28, 2007 Page 2 of 2
P:\Community Development\02 Administration\03 Forms - Official Versions\Permit Center\Residential Construction Permit
App 10.78.0/.dor.
2 of 2 2/26/2013 8:32 PM