2012, 05-21 Permit App: BLD-2012-0684 Addition, Remodel s
Community Development Department (Staff Use Only)
Permter
11703 EastCeSprague
�C:b—/�-a 1 2
rH 11703 Sprague Avenue, Suite B-3 PERMIT NUMBER:
scrry ' Spokane Valley, WA 99206
pokane Tel: (509) 688-0036 PERMIT FEE:
Valley (509):Fax688-0037
4.001.
pax: itcen enterPspokanevallev.orq
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
❑ NEW CONSTRUCTION ❑■ ADDITION/REMODEL El ACCESSORY BUILDING
❑ DECK ❑ OTHER
SITE ADDRESS: 15506 E 20TH AVE
ASSESSORS PARCEL NO.: 45252.3001 LEGAL DESCRIPTION:
BUILDING OWNER NAME: NGUYEN, NHA VAN & DAO IHI
NAME: NGUYEN, NHA VAN & DAO IHI
ADDRESS: 15506 E 20TH AVE
CITY: VERADALE STATE: wa ZIP: 99037
PHONE:509-228-0856 FAX: CELL:
CONTACT NAME: NGUYEN, NHA VAN & DAO IHI JU 5l'io To mete
PHONE: 509-228-0856 FAX: CELL: 5'09 "
CONTRACTOR NAME: NGUYEN, NHA VAN & DAO IHI 2.q N- gi107
MAILING ADDRESS: 15506 E 20TH AVE
CITY: VERADALE STATE: wa ZIP: 99037
PHONE: 509-228-0856 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:22, Dimensions: 14'X23'6° No. of Stories:n/a Total Habitable n/a
Space:
Main Floor SQ FT: Upper Floor SQ FT: Unfinished Basement SQ Finished Basement SQ
n/a n/a FT: n/a FT:n/a
Garage SQ FT: Deck/Covered Patio SQ Impervious Surface 30%Slopes on
n/a FT: Area: n/a Property: n/a
329
No. of Bedrooms:n/a Construction Type: Heat Source:n/a Sewer or Septic:n/a
TOTAL COST OF PROJECT: $ 5000
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
i
Signature Date: 5/21/2012
Method of payment: 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
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