2014, 07-24 Permit App: BLD-2014-1756 Remodel Community Development Department (Staff Use Only)
Permit Center
pF sxE 11703 East Sprague Avenue, Suite B-3 PERMIT NUMBER:
SpCITYokane Spokane Valley, WA 99206
Tel: (509) 720-2540 PERMIT FEE:
j Talley Fax: (509) 688-0037
\♦/ permitcenter@ sookanevallev.orqP'ot (Pa,
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
BIN NEW CONSTRUCTION Pt ADDITION/REMODEL ® ACCESSORY BUILDING
ill DECK III OTHER
SITE ADDRESS: /399? 4z-L )*L, L4 9/
ASSESSORS PARCEL NO.: 55003,570/ LEGAL DESCRIPTION: G.', 5c. frvaloeto Rip
BUILDING OWNER NAME:
NAME: 2/ti-rl p (1'D)'
ADDRESS: / J�l(;)9 • /�I tvez J J L Wilt
�
CITY:` 1.44-11/ STATE: WTZIP: 990/&i
PHONE: 6C /�► ' t7- - j FAX: CELL: 599.-- /_- 45
CONTACT NAME:
PHONE: .-- 5N___ 4 FAX: J -4 CELL: —9 3- J
CONTRACTOR NAME: tis_
MAILING ADDRESS: f 3�� M /1411 - � -�
CITY: 5g,1[,: buff e STATE: l ZIP: 7 jai- s-
PHONE: '5 ...-4 FAX: ct --.5 4545 CELL: e-9"3-- 3cetri
CONTRACTOR LICENSE No.:o '' lt4 lK 4 EXPIRES:7/ 2
CITY BUSINESS LICENSE NO.: /Z ) Q •
DESCRIBE THE SCOPE OF WORK IN DETAIL AND
INDICATE USE & PROPOSED USE: 4N5
I 'u&/ -71T- 4 r=-zx= . A
****YOU MUST COMPLETE THE FOLLOWING****
MARK N/A IF NOT T 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 ype: Heat Source: Sewer or Septic:
TOTAL COST OF PROJECT: $ 000 '
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 c des are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit is not a permit or appryvO fqr any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be required to be submitted/00 subsequently approved before this application can be processed.
Signature ;� �� Date: 7
Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/2743/Res_Permit.doc