HomeMy WebLinkAbout2004, 06-17 Permit App: BLD-04-04635 MH*km
4,010Valley
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 F. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688 -0036; Fax: (509) 688 -0037
REQUIRED SITE INFORMATION
Street Address:
Assessor's Tax Parcel Number(s):
Legal Description: /)/('55/,,),-) 71V , . y ,//f /071- 53
PERMIT DESCRIPTION: .5e/ 7/�� A ,., z
Building Permit
n Relocation
n Change in Use n Grading Manufactured Home
n Tenant Improvement 1 I Fire Safety f Other
OWNER/APPLICANT INFORMATION
n
Owner:
Phone{
Address:
114S i4I //5A/1"
Fax:
City
Ti Contractor:
Phone:
Address:
State
Zip Code
Fax:
City
State
Zip Code
Z C.
n Applicant:
q5-3---3y2_3 Fax: 727 -&7
Address: /5y /g
b0// -- 7
Cit9 State Zip Code
n Architect:
Phone: Fax:
Address:
City
WA State Contractor License #: Contact:
State
Zip Code
PERMIT /BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2'`'1' FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEME�,Q. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SO=
# OF BEDROOMS: -
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROINRTY:
SEWER OR ON-S �EPTIC
SYSTEM? Ate ! /G .6-7
MANUFACTURED HOME
Width:
Manufacturer:
Length: (e0
Year:
Pit Set: Ye s
RELOCATION
Previous Address:
Proposed Use:
Fire Sprinkler: # of Heads: Fire Alarm:
Tent: Fireworks Display: Blasting:
Valuation: Above /Underground Storage Tank Size:
Paint Booth:
Date/Time:
WASHINGTON STATE NON - RESIDENTIAL ENERGY CODE
Plans Examiner: Phone: Fax:
Address:
City State
Inspector: Phone: Fax:
Address:
Zip
City
State
Zip
SPECIAL INSPECTIONS
fl BOLTING (1 CONCRETE
Firm Name:
f REINFORCEMENT
Phone:
nspector(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 property owner.
Print Name 12i °tee' . A/9S�'L,
Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash
Bankcard #:
❑ Check
❑ Mastercard
Authorized Signature:
Expires:
,g VISA
❑ Other
VIN #:
AO'r.W111.01.4 •
ADDRESA
ZONE GL
ROAD WIDTH
FRONT _
COMMENTS
RE VIEWED SY
- being *MOM for thp p.liong. of
•rtin ail is a ti :t
:troprisal Al! )rr,r ty
••••
Also
oi,ill1111!
.11111011SWV•
11.1%.• bP(lf htt,•
1)0(11..S ,d
Signed
DOE
.lit• ettlidl
m&', critical oreas.
Z007
321 n13 n211s /A8oss333v
180d8VOAVM3A121a
w
0
z_ 321nionalS /A21oSS333Y
18OddV3 /AVM3A180
ONINMY
/)1330
z +F
w
0
J RiOnd{1S /ANOSS333v
f Io &JYO /JVM3A13IG
Q
cc
<
la_
0
'N17
'NI7
SPACE LIMIT LINE
4
a.
ix 0
o z
EE
t
'--5
Z
2
w
u)
0
1-
1
Z
4
M
ef) 0 in
0z<
0<
san3 30 move
0
♦Zi7
•
o_ z
tri
tUJ
0ce= —
01
z
0<
irR Lai
z
wQ b
co w°
°
din z
N M w5<
I--„< zreom
W POW
Id 14 Id id z
zoo
m��
0 re
LAJ
1:1-MQz
2 m It-
re CO 0
5
1OfIW