2007, 02-13 Permit App: 07000439 Safety Inspect �\ Permit Center•
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sokcxTv it I�""' I I ERMIT NUMBER: 7-61��'1
ane 11707 E Sprague Ave, Suite 10--6-),
S Spokane Valle WA 99206
� � P Y, FEB 7 PERMIT FEE: �7
,'�"' � (509)688-0036 FAX: (509)6$$=0037
Community Development www.spokanevalley.org
Safety Inspection (Adult Family Home
Permit Application Fire/Water/Vehicle Damage
Other:
SITE ADDRESS / 3 / C (tet i, CK
ASSESSORS PARCEL NO: LEGAL DESCRIPTION:
Building Owner: Contractor:
Name: ` Name:
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Address: a to L S '77
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(' Address:
City: .0 / 1 I State: �� Zips 03-7 City: State: Zip:
Phone: �c f�i Fax: Phone: Fax:
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Contractor Lic No: Exp Date:
Contact Person City Business Lic.No:
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Phone: 09 L0.,S y
Describe the scope of work in detail: Cost of Project: $
**************The following MUST be complete: (write N/A if not applicable)**********************
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES: TOTAL HABITABLE SPACE:
MAIN FLOOR TO SQ. 2ND FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: IMPERVIOUS SURFACE
FTG: AREA:
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?
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 processe
Signature.. Datec:22 —/3 C
Method of Payment:
❑ Cash ❑ Check Mastercard ❑ VISA
Bankcard#: Expires: VIN#:
Authorized Signature:
REVISED 8/25/2005
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