HomeMy WebLinkAbout2004, 10-13 Permit App: BLD-04-07917 MH00%,
�alley
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688 -0036; Fax: (509) 688 -0037
REQUIRED SITE INFORMATION
Street Address:
/?32.-3 Aguski Zeffri-e
Assessor's Tax Parcel Number(s):
Legal Description: /WOO k;,51 e3") Aeevz, 4Wp
PERMIT DESCRIPTION:
55053, e,O,
[� Building Permit
[l Relocation
(I
Change in Use [-1 Grading Manufactured Home
❑ Tenant Improvement f Fire Safety H Other
OWNER/APPLICANT INFORMATION
n Owner: 5444 e$4,4 talil
Phone:3 _7 .3_5s26, Fax:
Address:
City
State Zip Code
[-j Applicant: / ''c./14411/17.656)1-1
Phone: 953 - /z 3 Fax: 27 7 5-7
Address: /5-we A_ ‘a ,c,4,4., 1-
�/ LO/9 yra37
ay State Zip Code
(� Contractor: Aewne5 ❑
Phone: ax: ,3f --'3Z7
Address: L/005 v, S`p►T „atue
Z-
City State Zip Code
WA State Contractor License #:
Architect:
Phone:
Address:
Fax:
City
Contact:
State Zip Code
PERMIT /BUILDING INFORMATION
HEIGHT TO PEAK: / /
DIMENSIONS:_ �,
Z7
# QF STORIES :.
MAIN FLOOR TO SQ. FTG:
/ /Z
2ND FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
ir-e
HEAT SOURCE:
# OF BEDROOMS:
_
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON -SITE SEPTIC
SYSTEM? /,,1 f? /ice Sead,e4
olJz
MANUFACTURED HOME
Width: Z 7 Length:
Manufacturer: f-= j..eehr.90,,z(
Year: 7-4,0'{ Pit Set: ys
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm:
Tent: Fireworks Display: Blasting:
Valuation: Above /Underground Storage Tank Size:
Paint Booth:
Date/Time:
WASHINGTON ON STATE NON- RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
Fax:
City State
Inspector: Phone: Fax:
Address:
City
State
Zip
Zip
SPECIAL INSPECTIONS
n BOLTING n CONCRETE
Firm Name:
REINFORCEMENT
Phone:
Inspector(s):
Fax:
n WELDING
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 erty owner.
Print Name
Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash n Check ❑ Mastercard XVISA ❑ Other
Bankcard #: Expires: VIN #:
Authorized Signature:
...
'. Ls :.*g'.
sew .sw ... =h-
u1*1%; .•rrraw**•
tr**s.wur*� a
Wil
rr+*rriY ■.rr ■■*Nfr
Irr *H ******.'
t ra**rf* ■r Mrr/rrullU ISI
This site plan is being submitted for the purpose of
obtaining a building permit and is a true and correct
representation of the proposal. All known property
lines /dimensions, curb lines, structures and easements
have been identified. Also indicated are wetlands,
bodies of water, - e • st :._ .- ; other critical areas.
Signed:
Date:
L0 74 6,0 sandy GU/ nf'g ��� becc 4 (
? l 5/ 0hvh fn 7L U 7i; /!' i,� S "Ak waiv
SPOKANE COUNTY UTILITIES /SEWER & GFC
1026 W. BROADWAY, SPOKANE, WA 99260
(509) 477-3604
Received From / �'�
Site Address /17
.
Account Number %�%
Dollars $ 02‘23 / —S/ l!V
e
/44.
RECEIPT No. 04467
/Date Avg 20 eb
Tom' % C/, r • .• .' Il 1,3
HOW PAID
CASH
CHECK
MONEY
ORDER
B /a/IL&