2005, 07-26 Permit App: 05002619 MHon? (� 0
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DING PERMIT APPLICATION WORKSHEET
Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
one: (509) 683 -0036; Fax: (509) 683 -0037
REQUIRED SITE INFORMATION
Street Address:
Assessor's Tax Parcel Number(s):
Legal Description: Z/73
c)6_5—
M'S_57‘04
qbo(
PERMIT DESCRIPTION:
Change in Use n Grading Manufactured Horne
Relocation ❑ Tenant Improvement
n Building Permit
[1
11
Fire Safety 1 Other
OWNERJAPPLICANT INFORMATION
❑ Owner. 6/e/4/4 ///v /lJ
Phone: 32 3 E to 3 Fax:
Address: ,V, �%s5 G/
ikea Ci State Zip Code
n Contractor: ,7-/ 3 %»i 2
Phone: Fax:
Address:
,posi JV V 7 7
City State Zip Code
❑
n
Applicant: c r//%6%%,?_5cv►
Phone: ?,":3- -3923 Fax: z7-6.7c7
Address: /5-7/
ZJ 7.637
State "Zip Code
Architect:
Phone:
Address:
Fax:
City
WA State Contractor License #: Contact:
Spokane Valley Bus. Liscense #: Contact:
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: /5-,
DIMENSIONS:.,? , X 510 ,
# OF STORIES: /
MAIN FLOOR TO SQ. FTG:
2 "" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECKICOV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER ON -SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Width: 1-7/
Manufacturer:
Length: 57v
5 //he_
Year: Z cp.s Pit Set: L
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler. # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: Date/Time:
Valuation: Above /Underground Storage Tank Size:
WASHINGTON STATE NON- RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Inspector.
Address:
Phone: Fax:
City State
Phone: Fax:
Zip
City
State Zip
SPECIAL INSPECTIONS
II
BOLTING ( 1 CONCRETE ❑ REINFORCEMENT ❑ WELDING
Firm Name: Phone: Fax:
Inspector(s):
DISCLAIMER
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.
Ownership of resulting development rights granted by any issued permit inure to the pro• - y owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
Cash ❑ Check ❑ Mastercard
Bankcard #:
Authorized Signature:
Expires:
❑ VISA
VIN #:
El Other
SPOKANE COUNTY UTILITIES /SEWER & GFC
1026 W. BROADWAY, SPOKANE, WA 99260
(509) 477-3604
RECEIPT No. 03647
+, Date ! ' 2.6 "05 20
Received Froni C ' i 1 ( ; Z VI 2LtU I 4 1 l J&J� .iC-V� (2�7 f 4%-) -
Site Address 4=. ` -1 ?) (63 ,&U6 ..i5TA
Account Num
Dollars $ 1 t JC41 / P (G ('
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taining a building permit and is a true and corre t
presentation of the proposal. All known proper
I es /dimensions, curb lines, structures and easemen
ve been identified. Also indicated are wetland
dies of water ; e p s = • =.`; other critical area
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