2015, 08-12 Permit App: BLD-2015-1919 Additions • Community Development Department (Staff Use Only)
Permit Conte
• 11707 East Sprague Avenue, Suite 108 PERMIT NUMBER:
•S
cIn: Spokane Valley,WA 99206
Tel: (509) 720-5240 PERMIT FEE:
�' Fax: (509) 688-0037
:Valley oermitcenterPspokanevallev.orq
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
O NEW CONSTRUCTION ig ADDITION/REMODEL 0 ACcgSSORYB�UIIL/DING
0 DECK i D OTHER � ' �' IO I 1
SITE ADDRESS: 1a C-1:1 J P-iNci O- b (2 D -
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
OWNER/APPLICANT(CHECK BOX,IF MAIN CONTACT❑):
NAME: G)i LL tPrPA 4 JAC-k_I
ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: EMAIL:
CONTACT NAME:
PHONE: FAX: EMAIL:
CONTRACTOR NAME (CHECK BOX,IF MAIN CONTACT '1) P(ZECtS c U 4 DG--- J 1►>L
MAILING ADDRESS: t Z j 1-1 t— C— (Jl Cl (2_
CITY: t'""kA LE FALL`-- STATE: Ls�j ZIP: 1"71C)
PHONE: Z Zt) �t 3 FAX: EMAIL: C.
CONTRACTOR LICENSE No.: Pn�•EC t C_I) 2.3 s: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE & PROPOSED USE:
7--A-)c) /IDD/ Ti(.s?rJ A-' 7_ /c' - //7/Nt- • r r e7....I 6e9-,3/A-1
4
****YOU MUST COMPLETE THE FOLLOWING****
MARK N/A IF NOT 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 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- •erm or approval for any violation of federal,state or local laws,codes or ordinances. 6) Plans
or additional informatloh En be requir-:.to be s bmitted and subsequently approved before this application can be processed.
Signature (/./M Date: S//Z//S—