2012, 08-17 Permit App: BLD-2012-1344 Residence 1 CDro;,,'' . kf)-- OaZ"-` 4'Lk
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,r As, s �� Community Development Department (Staff Use Only)
...c v �,x R �'l ' - �" 'ti Permit Center
CITY OF. _•: 117,03 East Sprague Avenue,Suite B-3 PERMIT NUMBER:
'. Spokane Valley, WA 99206
d Tel:'(509) 688-0036 PERMIT FEE:
.000Tey Fax: (509) 688-0037
permitcenterCalspokanevallev.org
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
IX NEW CONSTRUCTION ❑ ADDITION/REMODEL 0 ACCESSORY BUILDING
0 DECK 0 OTHER l /
SITE ADDRESS: Ne-p2/ e, /5"774
/I2 /9 ve 4Ok(7/tP IJ Q�( & 7 57
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: Q f rJ azyaw 0 v Cr?
NAME: ` / ./1 /7 vC// 2, ` -(_,zl e_)-LeS Ge_ u /e9 C/ a
ADDRESS: ✓ rL / C.__!/V
CITY: V ,Q Par £( `ze STATE: ( E.)7 ZIP: ,S-77
PHONE: 6e9V ;7 LJ 7 FAX: CELL:/ '�e ���f
CONTACT NAME: l� „7�C -(DZ Gam&GL-L) 12/((/
PHONE: (6 79) 99_3 /�/ ‘J2FAX: CELL:�(f���/j G7
CONTRACTORIIIINAME:
MAILING ADDRESS: ,_f:3i-xe_.-e____
CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE QF WORK DETAIL �jIVD INDICATE USE & PROPOSED USE:
,` 1--3-y (-� eu--r- f/ry 7�-{p62—`e
(/ ****YOU MUST COMPLETE THE FOLLOWING****
MARK N ,A IF NOT APPLICABLE
Height to Peak: Dimensions: v�/ No.of Stories: 1 Total Habitable
/ Space:
Main Floor�.QbT: Upper Floor SQ FT: Unfinished Basement SQ Finished Basement SQ
/ 2 �( FT: FT:
Garage SQ FT: Deck/Covered Patio SQ Impervious Surface 30%Slopes on
4( , /t FT: Area:
,
No.of Bedrooms: Construction Type: Heat Source: (( ' e4Z Sewer or Septic: Sa<'e�JCc/c._
e CD
TOTAL COST OF PROJECT: $ (-::<2..37-7)0e...9-----...._
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.
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
Signature Date:
Method of payment: jki Cash ❑ Check ❑ Visa ❑ Mastercard
Bankcard #: EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 2 of 2
P:\Community Development\02 Administration\03 Forms-Official Versions\Permit Center\Residential Construction Permit
App 10.28.07.doc