2012, 06-05 Permit App: BLD-2012-0819 Residence 1`C� -2-GZ—o`6t�1
Permit Center . ri. ,.
*Octane o r *. -
11707 E Sprague Ave, Suite 106 —.�� ''
Spokane Valley,WA 99206p �
Valley (509)688-0036 FAX:(509)688-0037 '' --;„:: -_-,A,-,it-r-, i..,,.,g;-,+'
Community Development www.spokanevalley.org.com
Residential Construction3.New Construction o Accessory Bldg
Permit Application ❑ Addition/Remodel o Deck
❑ Other:
SITE ADDRESS F. 2 nol Imo”
ASSESSORS PARCEL NO: LEGAL DESCRIPTION: Lo+ / S h$ -10-0 S
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Name: A i Ci. . . , °I, , '01 St• Name: OA AU4. ,o,
Address: Address: s ,4 . S //, /3 A
City: Zip: City: i _ . 1/ ' Zip: '
Phone: Fax: Phone: 9 Z N- , q 6 y Fax: ' - - is, '
Lic No: Exp.Date:
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ie iti FITky�ii;6;.' -4:1: a 7 ';. -tx;V� ,efs ' -r a"Ka -'
City Business Lic No:
Name: 2t
Phone: - ' 2.4
Describe the scope of work in detail: Cost of Project: $ 7(O;000
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**************The following MUST be complete: (write N/A if not applicable)**********************
HEIGHT TO PEAK: , DIMENSIONS: t #OF STORIES: t TOTAL HABITABLE SPACE:
21 yz'6x5Y 336z
MAIN FLOOR TO SQ. 2Nu FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: IMPERVIOUS SURFACE
FTG: 16 76 /6 7/O AREA: N/n
FINISHED BASEMENT GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG: 30% SLOPES ON
SQ. FTG: 532_ PROPERTY: 4//A
#OF BEDROOMS:3 CONSTRUCTIO ' • . . i 0 SEWER OR SEPTIC?
tool Fn f No,fvr I a �w ruR S�e r
DISCLAIMER Project # f?'L/1•i . • il
The permitee verifies,acknowledges and agrees by their signatu 1 it is for cons ruction of or on a dwelling,the
dwelling is/will be served by potable water. 2) Owrership of this e y Permit inu - to the property owner. 3) The
signatory is the property owner or has permission tc represent the property owner in this transactio . 4) All construction is to be done
in full compliance with the City of Spokane Valley Development Cod � f rgn�des are avail.'le for review at the City of
Spokane Valley Permit Center. 5) This City of Spokane Valley Per n t or approval fo any violation of federal,state or
local laws,codes or ordinances.6) Plans or additioial information may be required to be submitted and subsequently approved before
this application processed.
JCSV PERMIT CENTER
Signature Vada-
SUB # ( REV. # I Date 6- 6--/ z
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Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash 0 Check 0 Mastercard 0 VISA 0 Other
Bankcard#: Expires: VIN#:
Authorized Signature:
REVISED 8/25/2005 •
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PLANNING DEPT. APPROVED
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DATE: 1-°1 C(12- _
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