2013, 12-26 Permit App: BLD-2013-2597 Foundation Community Development Department (Staff Use Only)
Permit Center
_ 11703 East Sprague Avenue,Suite B-3 PERMIT NUMBER:
SPolane Spokane Valley,WA 99206 PERMIT FEE:
Tel: (509)688-0036
Valley-
4.0 ‘ Fax: (509)688-0037 .s.,___,___ t._._.__.,__,..._ e_. ___.,..�...��.,..�_
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RESIDENTIAL CONSTRUCTION PERMIT APP k. N
D NEW CONSTRUCTION ADDITION/REMODEL n ACCESSORY 4kow NG /
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SITE ADDRESS:
ASSESSORS PARCEL NO.: ,...3Sf2 yo7.0q Yaf LEGAL DESCRIPTION: _ ___..R,
BUILDING OWNER NAME:
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NAME: / W % I,,, FM/l e �,•--
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. ADDRESS: E / l"l 0 r^fj o.- C •
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CITY: 5( 0 ,yot., C STATE: <A) A ZIP: 9
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PHONE: . FAX: CELL: / b , / 1
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CONTACT NAME: .( cy ,),_ Okol � tiv' /`1, • �?
PHONE: FAX: CELL: •J/P , 3 4t
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CONTRACTOR NAME: 4C k liiI.S i , • ,r S. ' . ' : ' •
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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 T APPLICABLE
Height to Peak: Dimensions: No.of Stories: Total Habitable
<9 fx 7b ) / Space: s'OO
Main Floor SQJT: Upper Floor SQFT: Unfinished Basement SQ Finished Baseme t SQ
ci 0 FT: 10 U FT:
Garage SQ FT: Deck/Covered Patio SQ Impervious Surface 3300/eSlope on
FT: Area: p y: ti-
No.of Bedrooms: .2 Constructio Tye: �r Heat Source: fO1cc < or Septic:
Type:
TOTAL COST OF PROJECT: $ 3-a'a
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
n. 4) All
the City of
Spokane Valley Development code. Referencedthis
liance wi
codes areavai able oroconstruction full
review at the City of Spokane Valley Permit Center. 5)ttThe 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 ,subs ently approved before this application can be processed.
Signature _ Date: /y) 0 cf.?
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Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/fiiestorage/124/938/210/948/1496/Building_Permit =Reskientiai_11-11-11
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