2015, 02-12 Permit App: BLD-2015-0260 Residence c2U1..0 Ii w GQ kr-N(1,1'14;p '
Community Development Department (Staff Use Only)
Permit Center
11703 East Sprague Avenue, Suite B-3 PERMIT NUMBER:
SCITY
pol�ane Spokane(50 ) W99206
�l Tel: (509) 720-5240 PERMIT FEE:
\itlley Fax: (509) 688-0037
permitcenter@spokanevallev.orq
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
NEW CONSTRUCTION 0 ADDITION/REMODEL 0 ACCESSORY BUILDING
0 DECK 0 9THER
SITE ADDRESS: 'S 5 C 5 . 1L\ (�-e
ASSESSORS PARCEL NO.: 3523-t. 1 t0Q1 LEGAL DESCRIPTION: Lot-7 f3 I1- ; (Zoo . ri'f
OWNER/APPLICANT (CHECK BOX,IF MAIN CONTACT❑): Dr J("-I S-C�-�
cjoct lam Gb
NAME: RECEIVED Qy
ADDRESS: FEB 1 z 2015
CITY: STATE: ZIP:
PHONE: FAX: EIIIrA�1.V PERMIT CENTER
CONTACT NAME: SUB # I REV. # 1
PHONE: FAX: EMA,ILL�, !� ���\Q`�
CONTRACTOR NAME (CHECK BOX,IF MAIN CONTACT C'I 0 CA \ 1 1 C Y \ c�' -�s
VCA N .) r , E y . I
MAILING ADDRESS: � � �� �� bl
CmrITY: %. 1—L1�=�l) :�_ �v. 1
PHONE: y- I b' lD ' FAX: `j)- \ _ -7 4 EMAIL: ,_IP`t t'Q. Pc s_ I 'Vit, bi
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 Pea , , Dimeensi :S No. of Stories: i Total Habiab
Space: L' I
Ma' floor SQ FT: Upper Floor SQ FT: Unfinished Ba ement SQ Finished Basement Q
1 Cc)/.3 -E3 FT: 1-& ,.0 FT: _
Garage SQ FT: Deck/Covered Patio SQ Impervious Surface 30%Slopes on
t 0 l FT: ` 9 1 t__\.-2._ Area: Property:
No. of Bedrooms: Construction Type: Heat Source: ei S CP.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 .ermit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans
or additional information m. be requir K be submitted and subsequently approved before this application can be processed.
Date: / !" cSignatur- i_Irt44...L....._
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