2012, 10-05 Permit App: BLD-2012-1753 Residence i Community Development Department
(Staff Use Only)
Permit Center
lrt. 11703 East Sprague Avenue,Suite B-3 PERMIT NUMBER: IJ -1Z- I 75.3
OF Spokane Valley,WA 99206
Tel: (509)688-0036 PERMIT FEE:
Fax: (509)688-0037
.•00ValleY• permitcenter@spokanevallev.orq .. ._H,._ - _ . .. ...
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RESIDENTIAL CONSTRUCTION PERMIT APF it A'T`lON
® NEW CONSTRUCTION ❑ ADDITION/REMODEL 0 ACCESSORY'BUILDING
❑ DECK 0 OTHER
/
SITE ADDRESS: / (Q I e" t v
ASSESSORS PARCEL NO.: 45244.3505 LEGAL DESCIPTION:15b2 Shelley lake 5 V_
BUILDING OWNER NAME: She (<e1 �11<L Oe%e L D cnq eo 7"---S ( -'
NAME: /
ADDRESS:
Com: STATE: ZIP:
PHONE: FAX: CELL:
CONTACT NAME:
PHONE: ) � FAX: CELL:
CONTRACTOR NAME: I tT() el t/AMS /---
MAILING ADDRESS: �D (! 3v 7'"/ l
CITY: KWH/. STATE: WA ZIP: 9"< 3
PHONE: S.-"Z'f/ -))1 3 FAX: 3 CELL:
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CONTRACTOR LICENSE No.: i/2j l a b(,a�
EXPIRES: 20 I CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETA L AND INDICATE USE & PROPOSED USE:
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****YOU MUST COMPLETE THE FOLLOWING****
MARK N/A IF N9T APPLICABLE
Height to Peak: i-7 Dimensions: No.of Stories: Total Habitable
. ei.X 6 / Space: / 7
Main Floor SQ FT: , 7 .' y Upper Floor SQ FT: Unfinished Basement SQ Finished Basement SQ
�i l FT: FT:
Garage SQ FT: 7 Deck/Covered Patio SQ Impervious Surface 30%Slopes on
g's/ ' FT: PM Area: Property:
No.of Bedrooms: Construction Type: Heat Source: 9/44
r 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
informatio may be required to be submitted and subsequently a..roved before this application can be processed.
Effective Octose 4;/17A/ f 4 ie-g-•W
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P:\Community Development\02 Administration\03 Forms-Official Versions\Permit Center\Residential Construction Permit
App 10.28.07.doc
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Proposed/Plot-Flaw I
16312 East 1Oth'Lan&
L. 5, Block 2 Shelley Lakes 5e"Ad tton ( J
Parcel.rar er45244.3505
SpokaneN, ►- Spokan&Courtty, Waattnfiton,Stoi.tee
SCALE 1: , 1 Pabltc,Setver and/Water
PLANNING DEPT. APPROVED
BY:
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