2015, 08-03 Permit App: BLD-2015-1857 Finish BedroomA
S`Iwane
P
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Community Development Department
Permit Center
1170_ East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 720-5240
Fax: (509) 688-0037
permitcenter@spokanevalley.org
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
[1 NEW CONSTRUCTION ADDITION/ REMODEL ❑ ACCESSORY BUILDING
DECK ❑ OTHER�d
SITE ADDRESS:
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION: j
OWNER/APPLICANT (CHECK BOX, IF MAIN CONTACT ):
NAME: V\G� Ija
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ADDRESScc�� 11�T2�O
CITY: J G (XVI VcAe STATE: ��% iT ZIP 1 ! I
PHONE: (`J0 FAX: EMAIL: 9/AAl'. eae
CONTACT NAME:
PHONE: FAX: EMAIL:
CONTRACTOR NAME (CHECK BOX, IF MAIN CONTACT ❑):
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: EMAIL:
CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OFaWORK IN DETAIL AND INDICATE USE & PROPOSED USE:
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****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: $ IU6c�
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 approved before this application can be processed.
Signature aal�/% 1PwiW Date: J / 3 /�
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Applicant Name: C�CIzs De
Site Address/parcel number:
Phone : ��� �) 570 - Y/ 3
REVIEWED FOR CODE COMPLIANCE
SPOKAN LLEY BUILDING DIVISION
FILE
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Applicant Name: C�CIzs De
Site Address/parcel number:
Phone : ��� �) 570 - Y/ 3
REVIEWED FOR CODE COMPLIANCE
SPOKAN LLEY BUILDING DIVISION
FILE