2010, 07-12 Permit App: 10002073 Demo Deck Community Development Department (Staff Use Only)
t- Permit Center
SC1TS oz 11703 East Sprague Avenue, Suite B-3 PERMIT NUMBER: \v-L01`3
pokane Tel Spokane Valley, WA(509) 688-00 699206.00PERMIT FEE: �
Valley. Fax: (509) 688-0037 2 \
permitcenter sookanevallev.orq
DEMOLITION PERMIT APPLICATION
PROJECT ADDRESS: 1 L lcAQ E . 3e-N-t. 4-ti
ASSESSORS PARCEL NO.: LIS 3.3 C ¢ 3`7 O(,
BUILDING OWNER NAME: C^2wCY . tc-OTtvhS
MAILING ADDRESS: ( Z i D(e e5S ' ►\
Ali
CITY: Gio6 kli,_cA.l2. 4a.) STATE: WA— ZIP: cqzo6,
CONTACT PERSON NAME: &14-70
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PHONE: 5 7o 2` FAX: CELL:
CONTRACTOR NAME: E,, CAC (K5 Co-v‘- -4-ivLci
MAILING ADDRESS: (2-07 IV . ` eJ1 S P ,
CITY: 5f 0LL-(`p_ Ur-Ate-1,4I. STATE: (�k ZIP:
PHONE: 5-0 ' 8 3 0 j , ( '3 FAX: CELL: G-09. 355- Z((p
CONTRACTOR LICENSE No.: C,OU„CC j f y(._ EXPIRES: (0421! CITY BUSINESS LICENSE NO.: lr32-9 I 6144
PROJECT DESCRIPTION (Please Provide Site Sketch) c kU
® Site Plan Provided 0' Notice of Intent # VY �p Jfi�
4Spokane County Utilities has approved the disconnection CA„L, ),,, v-
Describe the scope of work in detail (` f
DIb�� �c 15�+v1� f ou b cickc3�- rte.Ic 1.16 L vs-0J
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 s mitted and subsequently approved before this application can be processed.
Signature �,6llf45 Cheici Date: 7' 12 _/Z2)
Method of payment: ❑ Cash ❑ Check ❑Visa ❑ Mastercard
Bankcard #: EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
P:\Community Development\Forms\Building forms\Demolition Permit App.1.doc