2009, 06-11 Permit App: 09001695 Final Inspect 06/11/2009 13 : 18 FAX ACCESS MORTGAGE 001/002
(Staff Use Only)
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PERMIT NUMBER: OCC/ (0 !.C/
S—
leAT PERMIT FEE: 11v
CITY OF SPOKANE VALLEY
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
perm itcenter@ sookaneva Ilev.orq
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
i NEW CONSTRUCTION gpo4C6DITION/REMODEL ® ACCESSORY BUILDING
® DECK IN OTHER,/
SITE ADDRESS: '_ y - 1dv ��
ASSESSORS PARCEL NO.: * • • J LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME; tviKt:
1
ADDRESS: 10,74ZA 3 -17 1:did '/�' //�
Cny: 4l14t v�(' x Q STATE: �ZII�P; ___ [/(fp r
PHONE; col- 740 - c Ste5/l
FAX CELL: -7/, -eeS3
CONTACT NAME: /�
PHONE: .p FAX: . ` /Q '"D 3.S CELL: A'` / -66_13
3
?fee e -679 7g3r
CONTRACTOR NAME:
MAILING ADDRESS:
Cm: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR LICENSE EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
f '
PROPOSED USE:
Effective October 28, 2007 Page 1 of 2
http://www.spokaneva)ley.org/uploads/Community_Development/DoCuments/Forms/Building/Residential Construction Permit
App.1.doc
06/11/2009 13 : 16 FAX ACCESS MORTGAGE 002/002
****YOU MUST COMPLETE THE FOLLOWING****
MARK N A IF NOT APPLICABLE
Height to Peak: Dimensions: No. of Stories: Total Habitable
Space:
Main Floor SQ Upper Floor SQ Unfinished Basement Finished Basement
FT: FT: SQ FT: SQ FT:
Garage SQ FT: Deck/Covered Patio Impervious Surface 30% Slopes on
SQ FT: Area: Property:
No. of Construction Heat Source: Sewer or
Bedrooms: Type: Septic:
TOTAL COST OF PROJECT: $ IV/4 47/ LSC _
DI.SSLAIMER
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 Date:
Method of payment: 0 Cash ❑ Check ❑ Visa ❑ Mastercard
Bankcard #: EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 2 of 2
http://www.spokanevalley.org/uploads/Community_Development/Documents/Forms/Building/Residentlal Construction Permit
App.1.doc