2013, 07-11 Permit App: BLD-2013-1362 Residence Community;Development Department _._. (Staff Use Only)
Odel\ftnPermit Center
11703 EastSprague Avenue,Suite Ba-3- . PERMIT NUMBER:
CiTt� I Spokane Valley,WA 99206 -
Tel: (509)688-0036 PERMIT FEW:
Milky, pFaexrm: (t0e9n)tt808sa0o0k3a 'nXevallev`oEra ______
4000
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
0 NEW CONSTRUCTION 0 ADDITION/REMODEL 0 ACCESSORY BUILDING
0 DECK 0 OTHER
SITE ADDRESS: l (SLo\ p • 4% 6 La tat
ASSESSORS PARCEL NO.: 4-452_14-4. 3S4,0 LEGAL DESCRIPTION:
BUILDING OWNER NAME: 1ral.0 i e, f 10 he,n
NAME: Tro.(I e i\ .TheotLj I
ADDRESS: P D I ox 1.213
CITY: Ve i-citd a 1-e STATE: V"4 ZIP: q 0 --7
I
PHONE: J t)9 - Z I V -�-32 FAX: -- CELL: 609_<S A-q6`ff
7
CONTACT NAME:
PHONE: FAX: CELL:
1
CONTRACTOR NAME: �3 cave r — U*- 1IC T\ (rSth cnon,1 _C.
MAILING ADDRESS: 52_1 0 S• ,,)t)r(ICcV1 .Y\
CITY: CPOKa oc STATE: vA1A ZIP: i9q uL
PHONE: I3D I — "I'�5 32_141 FAX: CELL: 60q- i --2 ,--2.4-1
CONTRACTOR LICENSE No.: SPLIT pl✓"ti-7p EXPIRES: 10124),3 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: (III Dimensions: 1 No.of Stories: i Total Habitable
---/R,2_"
4Space: :122_
Main Floor SQ FT: Upper Floor SQ FT: Unfinished Basement SQ Finished Basement SQ
e2.11 ZZ Y1 by-1 C, FT: r\OV.F FT: r ovI C
Garage SQ FT: Deck/Cove ed Patio SQ Impervious Surface 30%Slopes on
FT: 9'� ). t�' Area: t coo Property: NI b
No.of Bedrooms: 5 Construction �rpe: (c_I�- Heat Source:pS�(Cic i Sewer or Septic: Se Wyk'
-krcurTOTAL COST OF PROJECT: $ Z�1'�/-39-gt.'
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.
G,�lz.,:dil 7170,01'uti .7/ 1 1 '13
Effective October 28, 2007 Page 1 of 2
P:\Community Development\02 Administration\03 Forms- Official Versions\Permit Center\Residential Construction Permit
App 10.28.07.doc
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