2014, 07-25 Permit App: BLD-2014-1782 Residence A
Community Development Department C Se OniyL)
Permit Center 11/"z u
11703 East Sprague Avenue, Suite B-3 PERMIT NUMBER:
sisokaloie\ft. Spokane Valley, WA 99206
Tel: (509) 720-2540 PERMITMI. 2 8 2014
Va.1 Fax: (509) 688-0037
perm itcenter@sgoka neva l lev.orq
CSV PERMIT CENTER
SUB AI R V.
RESIDENTIAL CONSTRUCTION PER A ' "1.11.11ATION
14 NEW CONSTRUCTION 0 ADDITION/REMODEL El ACCESSORY BUILDING
DECK ) / D OTHER
SITE ADDRESS: q 0( I l� �Ctrt.
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: P? "M V 3 („-. ,,,,,fit,
ADDRESS: i d Y D 2 P- tR L
CITY: : KG 4t. (/noic STATE: L/e/r'C- ZIP: r970 ,‘
2 7
PHONE: �1 f FAX: CELL: C7 ( ( -' J /
(P A (,/'('
CONTACT NAME: (
PHONE: FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS: _ a Vt '<----
CITY: STATE: ZIP:
PHONE: FAX: CELL:
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 to Peak: Dimensions: No. of Stories: Total Habitable ZZ q Co
Space:
Main Floor SQ FT: Upper Floor SQ FT: Unfinished Basement SQ Finished Basement SQ
FT: G,C?0 FT:
Garage SQ FT: Deck/Covered Patio SQ Impervious Surface 30%Slopes on
0 0 FT: Area: Property:
No. of Bedrooms: ' Construction Type: Heat Source: Sewer or Septic:
TOTAL COST OF PROSECT: $
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 represen the property owner In this transaction. 4) All construction Is to be done In full compliance with the City of
Spokane Valley Development cod . Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit Is not a rmit or approval fo any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
Information may be requiredbe submitted and s sequently approved before this application can be processed.
/'
Signature ! Date: r 7. 41 S�- /
Updated 1-11-11 Page 1 of 1
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