2006, 11-29 Permit App: 06004672 Safety Inspect Permit Center p�Z
SpO`�kane 11707 E Sprague Ave,Suite 106 ti PERMIT NUMBER: COY" `Tallev Spokane Valley,WA 99206 NOV Z PERMIT FEE: `
'� J (509)688-0036 FAX: (509)688 0037 2006
Community Development www.spokanevalley.org
Safety Inspection Adult Family Home-WABO
Permit Application Fire/Water/Vehicle Damage
V Other: 7?66 h'ov s g
SITE ADDRESS /3 2 CJ iS & • 1A/0C A<
ASSESSORS PARCEL NO: LEGAL DESCRIPTION:
Building Owner: Contractor:
Name: Name: 7S, ,.-F‘),--e..._ ,s- C O U
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Address: & kA)„:3)<, 57_,e /''65
Address: /'DUB-(`.�
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City:5f17sc,nv 6, t//-v...4 EY State:,l\ Zip:,96z/6 City: , , km,4,4_6 Y State:w, Zip:g,Z 0 6
Phone:1Z.,, -s,,,I Fax: Phone: - / Fax: F3‘-1! -CA'0 ‘,
6 Bei-SC�C�C�
Contractor Lic No: y fovts'2'lO Exp,Date:
Contact Person // City Business Lic.No:
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Name: / C S C,o c)�6-� (/3�e-,0 --)
Phone: c 2 g —o"3<-/‘
Describe the scope of work in detail: Cost of Project: $ /04 00 0
726/-<s,/.P Azi,o, STi2 v C77 1- 6(Sr/ci.c /may^/ )/ fni:3-c.L/----,r-,,r t---7j ls? -(-1.--z: 4-4-
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-t-/.v / G>lz.•c.1. v.-,r5 ,T74// iNG.R 6 L.E c---7 i21��s',/lL,/ jc: 6 -7700)= O.vS c.-o.f'6.
**************The following MUST be complete: (write N/A if not applicable)**********************
HEIGHT TOPEAK: DIMENSIONS: #OF STORIES: TOTAL HABITABLE SPACE:
i6 ' / PGv s6z r 7
MAIN FLOOR TO SQ. 2N° FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: AREA:IMPERVIOUS SURFACE
FTG: e9 JU
FINISHED BASEMENT GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG: 30% SLOPES ON
SQ. FTG: PROPERTY:
#OF BEDROOMS: CONSTRUCTION TYPE: HEAT SOURCE: SEWER OR SEPTIC?
tA,6)c/)/CAf--,4vl (
The permitee verifies,acknowledges and agrees by their signature that: 1) If this permit is for construction of 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) This 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 �� = Date /'_ 7- f,`- 67 -4
Method of Payment:
0 Cash ] Check ❑ Mastercard 0 VISA
Bankcard#: Expires: VIN#:
Authorized Signature:
REVISED 8/25/2005
BELFOR tom) BELFOR USA GROUP E. 10020 Knox -Suite 100, Spokane Valley WA.99206
Phone (509)893-0001
Toll Free (800)707-3601
Fax (509)893-0006 •
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11/29/2006 Page: 13
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