2014, 04-17 Permit App: BLD-2014-0803 Pole Bldg Community Development Department (Staff Use Only)
Perm11703 EastSpCenter ,
Ôkane
11703 Sprague Avenue, Suite B-3 PERMIT NUMBER:
Spokane Valley, WA 99206
Tel: (509) 720-2540 PERMIT FEE:
Fax: (509) 688-0037
40000..Val\JjlI,Ie3T
permitcenter@spokanevalley.org
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
NEW CONSTRUCTION M ADDITION/REMODEL ACCESSORY BUILDING
DECK OTHER
SITE ADDRESS: ft i F tJ `":.� LA.: . ,11.
ASSESSORS PARCEL NO.: Tom-A Zt.12Ap EGAL DESC • '
BUILDING OWNER NAME: 111. ` V' U4�,.' r"' 010e• -� .:=_. :--z_ :-.. �f
RECEIVED
NAME: V
�ADDRESS: (vL { L Y I APR ( 7 2014
CITY' Gtt. STATE: Vv F,7I. f„ rR
-
PHONE: FAX: CELL:- 0 ! Iowa
II
CONTACT NAME:
PHONE: FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE: 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:
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
ISoo 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 feral, state or local laws, codes or ordinances. 6) Plans or additional
information may be required to be ubmitted and subsequently approved b fore this application can be processed.
Signature , (1.) -TiDate: 4.- 11
Updated 1-11-11 Page 1 of 1
C:\Users\Justin\Downloads\Res_Permit(1).doc