2014, 09-12 Permit App BLD-2014-2178 Residencecrra �� 's+a Permit Center
�O ne 11707 E Sprague Ave, Suite 106
.0,000.Valley
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development www.spokanevalley.org.com
Residential Construction
Permit Application
SITE ADDRESS
CSV PERMIT CENTER
K New Construe igp B # so5ypli---
❑ Addition/Rem&d-el ❑ k
❑ Other:
ASSESSORS PARCEL NO:
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LEGAL DESCRIPTION:
Name: Di ovev ,A0) 1Z,s,c Coy s t
Address:
City:
Zip:
Phone: 9z q K Fax:
Name:
Phone:
Describe the scope of work in detail:
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" . • (ter
Name: D; a MO4
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Address: 7_ C 6 2
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City:
Zip:
Phone: 9 Z g- yq 6 q
Fax:
Lic No:
.Exp. Date:
City Business Lic No:
Cost of Project:
$ 1ZS,00O
**************The following MUST be complete: (write N/A if not applicable)**********************
HEIGHT TO PEAK:
2
DIMENSIONS:
# OF STORIES:
c
TOTAL HABITABLE SPACE:
/W ON_.Nv
MAIN FLOOR TO SQ.
FTG: 6 Y 0 . (\
2Nu FLOOR SQ. FTG:
76 Zxr,`,
UNFIN BASEMENT SQ. FTG:
0
IMPERVIOUS SURFACE AREA:
FINISHED BASEMENT
SQ. FTG: O
GARAGE SQ. FTG:
Y3o
DECK/COV. PATIO SQ. FTG:
/60
30% SLOPES ON
PROPERTY: A/1/4'
# OF BEDROOMS: 3
niCI-I A1111100
CONSTRUCTION TYPE:
wool ram me_
HEAT SOURCE:
/41a tu-r et I Gas Fut rrta. c e
SEWER OR SEPTIC?
52 �€r
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) 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) 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 processed.
Signature
Date
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN#:
❑ Other
Authorized Signature:
REVISED 8/25/2005