2013, 04-24 Permit App: BLD-2013-0715 Remodel Community Development Department (Staff Use Only)
, Permit Center
OF -- 11703 East Sprague Avenue,Suite 8-3 PERMIT NUMBER:
SCITY11�! +gyp .. Spokane Valley,WA 99206
poke Tel: (509) 688-0036 PERMIT FEE:
va��e Fax:;(509) 688 0037
.000PermitcenterC�sookanevallev.orq
RESIDENTIAL CO
INSTRUCTION PERMIT APPLICATION
Ej NEW CONSTRUCTION U ADDITION/REMODEL -. ACCESSORY BUILDING
El DECK El OTHER
SITE ADDRESS: i?O d i C )-2112
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAr
ME: 6116,4i✓iO/I ^00/--
ADDRESS: P)-O?1 !� I9 / II
CITY: �Ve3 Gele
•.✓it v ` y STATE: 14)4 ZIP:
PHONE: .110 -- s'6Y - 96- --7 FAX: CELL:
CONTACT NAME:
PHONE: FAX: CELL: -
CONTRACTOR NAME: LIG•= Cp•e .,.1-l .g.C4-IC,)1 . -
MAILING ADDRESS: j3O9 /0, I Jar £&'7 • �j•
CITY: --IT ...17z-- Rc STATE: t,�,4 ZIP: L c�®c)6
PHONE: FAX: CELL: SC"j-Ff0 -8:
CONTRACTOR LICENSE No.: G-T'GJJ i3 EXPIRES: 7-7-/1/ CITY BUSINESS LICENSE NO.: 7-3}�0
^13
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
Space:
Main Floor SQ FT: Upper Floor SQ FT: Unfinished Basement SQ Finished Basement SQ
FT: FT:
Garage SQ FT: Deck/Covered Patio SQ Impervious Surface 30%Slopes on
FT: Area: Property:
No.of Bedrooms: Construction Type: Heat Source: Sewer or Septic:
TOTAL COST OF PROJECT: $
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 requiredto be submitted and subsequently approved before this application can be processed.
re/
Signature C _- Date: -,2-1/- i 3
Updated 1-11-11 Page 1 of 1
http://www.spoka nevalley.org/filestorage/124/938/210/948/1496/Building_Permit_-_Residential_11-11-11.doc