2014, 10-15 Permit App: BLD-2014-2542 Retaining Wall 2W-104 q1--mss 1'2-
Community Development Department Project # (Staff Use Only)
ermit Center
S11701East Sprague Avenue, Suite B-3 PEdI'II ek--n Spokane Valley, WA 99206
3C[pokane Tel: (509) 720-2540 PERM i E:15 � ;4
Valley Fax: (50�) 6aa 0037
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.00.0
CSV PERMIT CENTER
RESIDENTIAL CONSTRUCTION PERMiTaP L,ATIa
0 NEW CONSTRUCTION ADDITION/REMODEL El ACCESSORY BUILDING
DECK El OTHER
SITE ADDRESS: 1 b i S, (�8. „„a,;:I- D C'
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: Q..c:-I -r4- w.rp-L.
NAME: ,[-. c 0--rk ?oT7 —Dl.l-v]yL
ADDRESS: , 1 S S, 0,c9- —.ow- ' -
CITY: Sec:, lc-,-,,.z \/Q(sl, STATE: '2.--)A ZIP: c)cj O-K
PHONE: IC Sc1 a1 `') 2 4( 4 Ks /6 FAX: CELL:
CONTACT NAME: la c(,„,-,Q -.1 .,Q
PHONE: cc 01 CMZ q `(S I G FAX: CELL:
CONTRACTOR NAME: ca, p kr".r_.,;,,,\ Ce,
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE: p FAX: CELL:
CONTRACTOR LICENSE No.: g PC *# L.V O) 16 O EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE. THE SCOPE OF WORK IN /DETAIL AND INDICATE USE & PROPOSED USE:
n
K-cn,\.o.csz e igk\x-.off ci-os..lrvc^8Q 4-1.-e v'eirc:;,,:••, wailkaCl r.-;d-e..-, 0c(.c2.c--,3 c-ie4,,•u.•,i
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****YOU MUST COMPLETE THE FOLLOWING****
MARK N A IF NOT APPLICABLE_
Height to Peak: Dimensions: No. of Stories: Total Habitable
Space:
Main Floor SQ FT: Upper Floor SQ FT: Unfinished Basement SQ Finished Basement SQ
FT: FT:
Garage SQ FT: Deck/Covered Patio SQ Impervious Surface 30%Slopes on
FT: Area: Property:
No. of Bedrooms: Construction Type: Heat Source: Sewer or Septic:
TOTAL COST OF PROJECT: $ (S 0 D D
I
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 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 submitted and subsequently approved before this application can be processed.
Signature t�� A
Date: i°//s /ee,/9
Updated 1-11-11 Page 1 of 1
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