2012, 09-24 Permit App: BLD-2012-1660 Pole BldgSciiiikane
("Immunity Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 720-2540
Fax: (509) 688-0037
permitcenter@spokaneval lev.orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
Project 7 -
!2- `/b
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
0 NEW CONSTRUCTION 0 ADDITION/REMODEL ACCESSORY BUILDING
0 DECK 0 OTHER
SITE ADDRESS: 'S--7 T3i4 S . U `ilk `Spo ,C) IU -'4`9 Q oa C Lo
ASSESSORS PARCEL NO.: 3?,( 214(:) LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: P\\ er1 \ IVLq'
ADDRESS: '-'673� S. \ n
Cm:
PHONE:
STATE: U,...\3‘ ZIP: C 9 acs �o
FAX: CELL:
CONTACT NAME: ](')`\ 6 ¶>Av iC CYC
PHONE:
FAX: -77t
CONTRACTOR NAME: cj Q t i ¶3' Cki A V --P
CELL:
MAILING ADDRESS:
CITY: Cbl _>OiL.u`I , /
PHONE: q -( 6�j l - 77(oq FAX:
STATE: L& Pr
ZIP: q al c.3.1
CELL:
CONTRACTOR LICENSE No.: SOLI t)SL-C 1() EXPIRES: 14/ 0() t, 3 CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN ETAIL AND INDICATE USE & PROPOSED USE:
3(<c< 1,o ado k���.1(L Y c\
****YOU MUST COMPLETE THE FOLLOWING****
NIA IF NOT APPLICABLE
Height to Peak: 1 I
Dimensions: 3e) SD
No. of Stories: l
Total Habitable NI
Space: IcN
Main Floor SQ FT: iUpper
l• -j A
Floor SQ
ll Oc
Unfinished Basement SQ
FT: I A
Finished Basement SQ
FT: N) Y--‘
Garage SQ FT:
I cJ
Deck/Covered Patio SQ
FT: 0) Pk
Impervious Surface
Area: ' q 4 Z ,
30% Slopes on
Property: tJ i YA
No. of Bedrooms: Kip
Construction Type: Nie 0
Heat Source: 1\31 P
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 approva •= -tion of federal, state or local laws, codes or ordinances. 6) Plans or additional
Information may be required to be subml =- - d subsequently a..roved before this application can be processed.
4-,r6c-ex)
Signat
Date: ( _2 2.c j -
Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Building_Permit-_Residential_11-11-11.doc
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PLANNING DEPT. APPROVED
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