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2009, 06-11 Permit App: 09001695 Final Inspect 06/11/2009 13 : 18 FAX ACCESS MORTGAGE 001/002 (Staff Use Only) ► _ e\ilorak 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