2013, 06-10 Permit App: BLD-2013-1057 Residence , ,mmunity Development Department (Staff Use Only)
_rmit Center
11703 East Sprague Avenue, Suite B-3 PERMIT NUMBER:
Spokane Spokane
(50 ) Gley, 03 99206
Tel: (509) 688 0036 PERMIT FEE:
Valle Fax: (509) 688-0037
Y
permitcenter@sookanevallev.orq
4.00
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
NEW CONSTRUCTION ❑ ADDITION/REMODEL E ACCESSORY BUILDING
DECK Kt OTHER
SITE ADDRESS: 12 0 t1 r (4.712 /` '` s ,,
ASSESSORS PARCEL NO.:<`3j50A\ LEGAL DESCRIPTION: (
BUILDING OWNER NAME:
NAME: h �t�J� r a6-,.. L(S /cv/.4.' k 1' .r •- r�
ADDRESS: 7/2 t' C i J 1 e"4. 0
. �r
r
CITY: ,,J C' _/ 2 /2 ` 2 //k y STATE: �Y iii. ZIP: t( -9/ 2
4 ) 7/ V
PHONE: ' t/5"/ SIJ' _. /. f FAX: CELL:
i
CONTACT NAME: _C2 A'r'.17.-C--_. (�/h.s 7, 0 /a 4r7
PHONE: FAX: CELL:
CONTRACTOR NAME: 2 r. i�_t' S (" :--' f s / (4 At ,, �-O
MAILING ADDRESS: 7 / /, 4/' ( 1/C ' e d' 4?6 �j
CITY: G, / .e k i.
/' �/' ! � STATE: (' / /` ZIP: Cr �..)7.4,
PHONE: 5.,.�' % 1 /6.„2, /2(~ 7?FAX:
CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE & PROPOSED USE:
****YOU MUST COMPLETE THE FOLLOWING****
MARK N/A IF NOT APPLICABLE
Height to Peak: Dimensions: No. of Stories: Total Habitable
Space: Clog Sf
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
34,2 SP- FT: Area: Property:
No. of Bedrooms: Construction Type: Heat Source: 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 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.
1.
A r Date: - .
Signature ` G� /
/7 £' /
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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