2012, 08-27 Permit App BLD-2012-1431 ShedSpokane
1.Valley
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter(a sookanevallev.orq
El NEW CONSTRUCTION ❑ ADDITION/REMODEL a -ACCESSORY BUILDING
❑ DECK ❑ OTHER
SITE ADDRESS: / , (, / Gx-0ot4 I -iN),�
ASSESSORS PARCEL NO.: 4/qn5-f. 9 743 (Z,L.
LEGAL DESCRIPTION: / ci % sT
BUILDING OWNER NAME: /27 r Q/7v. t7 % YJ.�9-< .; r.' L= i� 7 , "tc r 1{4 /���.z
NAME: // )r l' ..L4 �4'J Y �fg— t t S �'r'/Yi % / A- Ct?' 9 i4- f�24 's�s
ADDRESS: / D 6,,/ ' E
CITY: j);
PHONE:
CONTACT NAME: 9 5-, 7/<5:-
PHONE:
STATE: i
FAX: CELL:
FAX: CELL:
DP: 9q za6
CONTRACTOR NAME: —r)
MAILING ADDRESS:
CITY:
STATE: ZIP:
PHONE:
FAX:
CELL:
CONTRACTOR LICENSE NO.: fide 6IaC? 3yp;z EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OWORK IN.DETAIL AND INDICATE USE & PROPOSED USE:
n e3Ahc, i
****YOU MUST COMPLETE THE FOLLOWING****
Height to Peak:
C ' / 0
Dimensions:
/ `1 r < if 6, '
No. of Stories:
/
Total Habitable
Space: �-i!
if
Main Floor SQ FT:
A
Upper Floor SO FT:
IL; i t
Unfinished Basement SQ
FT: J4)
Finished Basement SQ
FT: i ' /i-
,Z
Garage SQ FT:
k 6-
Deck/Covered Patio SQ
FT: ,j A
Impervious Surface
Area: . ,,✓j �
(
30% Slopes on
Property: Icy �-
No. of Bedrooms: ()
Construction Type:
Heat Source:
Sewer or Septic:
TOTAL COST OF PROJECT: $ L2/ 0 r0 6
pISCLmIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit i9`�Qt� E%Q� we wel + i III
be served by potable water. 2) Ownership of this City of Spokane Valley permit inure to the pr perty ow eD, e i -Sturgis die IA0 y
owner or has permission to represent the property owner in this transaction. 4) All cons ruction is to be ilon dry h111 cor I" ph the City of
Spokane Valley Development code. Referenced codes are available for review at the City of Spokane V'attey Permit C 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 ma . requ -d to be submitted and subsequently approved before this appication can be proceAst 2 7 2012
Effective-c ober 28, 2__
P:\tgmmunity Development\02 Administration\03 Forms - Official VersionsP .l{jt,enter-
App 10.28.07.doc V *`
P E: F r! T^ C r.iliseFl of 2
idential Construction Permit
rEL 1
Signature
Date:
Method of payment: ❑ Cash ❑ Check
Bankcard #:
❑ Visa ❑ Mastercard
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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