2015, 01-20 Permit App: BLD-2015-0091 . -zb. 5.-o
Community Development Department
...;..__..., Permit Center 1
11703 East Sprague Avenue,Suite 8-3 PERMIT NUMBER: „_
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Spokane Valley,WA 99206 fi�n,p��l 7 �r,�
Tel: (509)720-2540 PERKTr.14'6 2 0 2u iv i
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Vallex fax: (509)688-0037
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CSV PERMIT CENTER I
SUB # _ f I REV. # L III
RESIDENTIAL CONSTRUCTION PERF`
151, NEW CONSTRUCTION 0 ADDITION/REMODEL 0 ACCESSORY BUILDING
0 DECK 0 OTHER
SITE ADDRESS: / 2fI L F2/ 641"//WC
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: Ntaktrieum atmLs.1\ c.
NAME: .._riL-}v'%l l`l1 Si-trAq,4 LAI-
ADDRESS: �b . " N[3c
Crus Sp 1c .e L r STATE: 1* ZiP: ��7 Zt
•PHONE:(-.5v4\} 12" - -1q330 FAX(- f i q['1-` et!.o i CELL: 1} "7/41 I i/
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CONTACT NAME: f t t<.s 1 €r a..41f1Y11 Yt".
-PHONE: 5Z1. /Z FAX;lY ??' FAX: TV// - 72({'42( CELL: 6j.'77-4 - ',-(p - 7 /r/
CONTRACTOR NAME: l to 1;ta4A , ,7-6.4.44 114 . ,
MAILING ADDRESS: PD. YI,e II( ()
crrn SA /L flak:. STATE: WA / Zip: f /4f/
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PHONE: 7i�1 c 2-3- �J- /Y 3 FAX( v 1 I 92 iii-T tOta 1 CELL: j r,) ;21"V - 15-7(
CONTRACTOR LICENSE No.:1441.4K14 J# c4/.)K EXPIRES: 3OAS' 2TV BUSINESS LICENSE NO.: l izG.DYLCe 1,1:31
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DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE & PROPOSED USE:
****YOU MUST COMPLETE THE FOLLOWING****
MA:- A IF L •T • PP • :LE
Height to Peak:, Dimensions: 2.4 y.L� No.of Stories: b� Total Habitabl�9fq
Main Floor SQ FT: Upper Floor SQ FT: Unfinished Basement SQ Finished Basement SQ
,�, A-ii.I FT:A)/4 PT: %u'/,a
Garage SQ FT: Deck/Covered Patio SQ impervious Surface 30%Slopes on
S ie PT: /J i Area:1 PrePer J�
I No.of Sedroon:s: 0 Construction Type: fJ .3 Heat Source: ail Sewer or Septic:
TOTAL COST OF PROSECT: $
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 , approval for any violation of federal,state or local laws,codes or ordinances. 6) Plans or additional
information may be required to be omitted and subsequently approved before this application can be processed.
11\4 Signature '‘ kn N.-.._.___ Date: 4.j
Updated 1-11-11 Page 1 of 1
http:/twww.spokanevalley.org/ftlestorage/124/938/210/948/1496/2743/Res_Permit.doc