2013, 03-12 Permit App: BLD-2013-0402 Residence ..
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ler Community Development Department (Staff Use Only)
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. . 11703 East Sprague Avenue, Suite 5-3 PERMIT NUMBER:
Spokane Valley,WA 99206
POlialle Tel: (509) 688-0036 PERMIT FEE:
Valley' Fax: (509)688-0037
permitcenterOspokanevalley.011 AES=02k, APIMMEESts
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
[p(NEW CONSTRUCTION 0 ADDITION/REMODEL 0 ACCESSORY BUILDING
U DECK 0 OTHER
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SITE ADDRESS: lit ' el
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ASSESSORS PARCEL NO.: LEGAL DESCRIPTION: ....__
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BUILDING OWNER NAME:
NAME: p,+ ( ,,„( /3 c44(2_ I el/69 (.....,
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ADDRESS: 1 4) I?0 d a 2_"eotAy e__
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CITY: S2f) .1, I( a LA..k. (/'6 P•e y STATE: a/ 4 zip: 9 q 0(6
PHONE: Q ) q - I 7 ,..Z FAX: CELL:
CONTACT NAME: 0
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PHONE: FAX: CELL:
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CONTRACTOR NAME: 0:)0e, ( Cioe,ti51 i,azei 0 IV 0 r 74(../..e.-." . 43
MAILING ADDRESS: tri 10 0? 0 cil
01 _
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CITY: /C id 1147 ZIP: Q (a ( -4
c j f,0 Of(„4-e..., 1, STATE: (4..1 ii
PHONE: 611 9 - ---' I 7 ,-2..... FAX: CELL:
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CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE & PROPOSED USE:
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****YOU MUST COMPLETE THE FOLLOWING****
MARKII/A IF NOT APPLICABLE
Height to Peak: Dimensions: No. of Stories: Total Habitable
'.; ' t Space:
Main Floor SQ FT: 1 a k 0 Upper Floor SQ FT: Unfinished Basement SQ Finished Basement SQ
FT: FT:
_....Garage SQ FT: .4 00 Deck/Covered Patio SQ Impekk=face 30%Slopes on
FT: Area: Property:
No. of Bedrooms: s*-1. Construction Type: Heat Source: ewer Septic:
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TOTAL COST OF PROJECT: $ I 3 0_ OPO
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DISCLAIMER
The permitted verities,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) Ail construction is to be clone 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 per mit or approval for any violation of federal, state or local laws,codes or ordinances. 6) Plans or additional
information may be requiri,d to be submitted •nd subsequently approved before this application can be processed.
Signature OIP Date: 0 2,- . 1 A , i 3
Updated 1-11-11 Page loft
http://www.spokanevalley.orgifilestorage/124/938/210/948/1496/Building_Permit_-_R.esidential_11-11-11.doc
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