2015, 06-24 Permit App: BLD-2015-1480 Pole bldg Community Development Department (Staff Use Only)
Permit Center
11707 Eatt Spiragtie Avenue, Suite 108 PERMIT NUMBER:
•SCIT1
YOF �� Spokane Valley,WA 99206
Q Tel: (509) 720-5240 PERMIT FEE:
Fax: (509) 688-0037
Valley permitcenter@spokanevallev.orq •
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
le7NEW CONSTRUCTION 0 ADDITION/REMODEL fl ACCESSORY BUILDING
0 DECK f it• OTHER
SITE ADDRESS: A / Ar - P 301S " ea
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
OWNER/APPLICANT(CHECK BOX,IF MAIN CONTACT❑):
NAME: R1h iia" x Ic--K--
ADDRESS: //1/ .—.5–k/ /%A?
CITY: •o / / _ _ STATE:�'�/ `G.� ZIP: a.v�1
i
PHONE: FAX: EMAIL:
CONTACT NAME:
PHONE: FAX: EMAIL:
CONTRACTOR NAME (CHECK BOX,IF MAN CONTACT❑):
MAILING ADDRESS: i,ii• 5 ��J-L�7-ac,74,
CITY: II -� i f I eITA . ZIP:
,..,C,57PHONE: 0ZZ. –Jg/ FAX: EMAIL: L7/'c)5s/ "•,. /p/d
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CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE & PROPOSED USE:
****YOU MUST COMPLETE THE FOLLOWING****
MARK N/A IF NOT APPLICABLE
Height to Peak: Dimensions: No. of ories: 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: $
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 ved before this application can be processed.
Signature �ti�— / Date: � �