2012, 10-04 Permit App: BLD-2012-1751 Garage f 1
Community Development Department (Staff Use Only)
Permit Center
11703Sprague East Sprague Avenue,Suite B-3 PERMIT NUMBER:
TpokaF Spokane Valley,WA 99206
Tel: (509)688-0036 PERMIT FEE:
Fax: (509)688 0037
pax: (5 9)68 spokanevallev.orq
d•••0IFValley
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
❑ NEW CONSTRUCTION pgADDITION/REMODEL 0 A&gSSU1#8LIG -
❑ DECK ID OTHER L I V E D
SITE ADDRESS: I .2 S; 5 V IT t v` IL-Q.-
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION: OCT s 4 2012
BUILDINGLOWNER NAME: PFRMIT +"FM►TER
NAME: S'7((./`k. 1.._ln-T12'w, y�C1 G� SUB # J— REV. f
ADDRESS: I�.c2 J S V 1 trs,t^`J1�
cm:5-poke.tit-S2 (Ic.I jF 1 STATE: U/,A. ZIP: / `/a 1��
PHONE: ) DO) — I FAX: CELL:
CONTACT NAME: J.--1
PHONE: 5v 9 --£-.j ( 0 -j ( FAX: CELL:
CONTRACTOR NAME: L4 Le5<< Ca-y,.o-y G,G.+l - t11'1 ill--
MAILING ADDRESS: )a )1 5 • LA)C 1 3G 6( VC-' . , , /
Cm: L 1 b-C'''+�/ ��.ke--7 STATE: (4 A. ZIP: g 9
PHONE: S 0 Ll C--/ J` 3 0-7 I FAX: - 3 1S ` Z ..1"r CELL: SJ -445 I f O7 /
CONTRACTOR LICENSE NO.:Lc%k Z 5C he q -gEXPIRES: j O)'-'lI q CITY BUSINESS LICENSE NO.:60),i 0 9-)60
DESCRIBE THE SCOPF OF WORK IN DETAIL AND INDICATE USE &PROPOSED USE:
r d2 I C. x 16 ' 6,1 Do.] 44,4. ,�, -r- Qx, s* '•) <:
Tb ul 1 b JTZ✓'? Vh T-/7Y.C 7C/P 5 + 3F(.7`(`4-5 er--
****YOU MUST COMPLETE THE FOLLOWING****
MARK N/A IF NOT APPLICABLE
Height to Peak: d Dimensions- , No.of Stories: Total Habitable
IC '$I( i Space: y.g
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
25 62 FT: Area: 5 Property: /06
No.of Bedrooms: Construction Type: Heat Source: Sewer or Septic: &,,��,J),
TOTAL COST OF PROJECT: $ S S 0 (J
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.
Effective October 28, 2007 Page 1 of 2
P:\Community Development\02 Administration\03 Forms-Official Versions\Permit Center\Residential Construction Permit
App 10.28.07.doc
Signature .;6 �� �/�'�/ Date: /0/51/.2_
Method of payment: 0 Cash 0 Check 0 Visa 0 Mastercard
Bankcard #: EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 2 of 2
P:\Community Development\02 Administration\03 Forms-Official Versions\Permit Center\Residential Construction Permit
App 10.28.07.doc
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