2013, 03-08 Permit App: BLD-2013-0376 Tear Off, Reroof R-08-2013 08:42 From:PFRRFNnIIn Pnncrmr_ ^, 937 P.1'1
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S' e This document originally contained confidential credit card / - 2.40t3- o 5-74.information which was redacted pursuant to RCW 19.255.010 PE T NUMBER:
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PERMIT FEE: if 14.?r
Community Develops G52014-030. 7
Residential C AIew construction ❑ Accessory Bldg
Permit Application a Addition/Re del ; o Deck
et-
16-1/12- . / — o Other: _fry
19 414
ASSESSORS PARCEL NO: LEGAL DESCRIPTION:
Building owner Contractor. • • • .
•
Name: 14)h1 )erla0 S:(re-i +IU\ Name:
Address: j S Li o S i q -, Address: t?.
City: ep (f-.1(e/ qg 637CitY151iD1<is..- r !2-43. Zip: (/aO 9 7'
Phone: Fax: Pion:/333--7/6j Fax:
„_ Lie No:tarra 'Aan Exp.Date
Contact Person':. : .,, ,: =
“ :.: . .:_ City
Name: a'kA t fre401L Business Lie No:
Phone: cicti4-(a`?QS
Describe the scope of work in detail: Cost of Project $ I S, 7e °
ACc,..isr).+-,4--- W.......eafreg At- re rEvP ______. .
**************The following MUST be complete: (write N/A if not app[ieebl_0�_'*+******************4
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES: TOTAL HABITABLE SPACE
MAIN FLOOR TO SQ. 2FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: IMPERVIOUS SURFACE
FTG: AREA:
FINISHED BASEMENT GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG: 30% SLOPES ON
SQ. FTG: PROPERTY:
#OF BEDROOMS: CONSTRUCTION TYPE: HEAT SOURCE: SEWER OR SEPTIC?
DISCLAIMER
The permitee verifies,acknowledges and agrees by their signature that: 1) if this permit is for construction of 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) AN 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) This 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 pro ed.
Signature Date 3-6-I
Method of Payment (Faxed permit applications will only be accepted with major banked)
❑ Cash 0 Check 0 Mastercard lgr Visa
Bankcard#: REDACTED - - "' Expires: ' Vl
PACTED REDACTEt Other
Pn
Authorized Signature: .....-- 40""..... .iiige/.....0... -- '.-
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