2005, 03-17 Permit App: 05000815 Demolish ShedD II
Spokane
Vaiiey
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
Street Address:
REQUIRED SITE INFORMATION
173/
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
I1
Building Permit
Relocation
I
II
Change in Use
Tenant Improvement
I1
Grading
Fire Safety
Manufactured Home
Other
Ij
OWNER/APPLICANT INFORMATION
Owner: /64 „/
Phone: 9; /i // F
Address: A,/ .67
A��
Ci
State
Zip Code
Applicant:
Phone:
Address:
Fax:
City
Contractor: ����— ��,•- rC:,Q� I I Architect:
Phone: �,2 3j3 Fax: Phone: Fax:
Address: J. 7300 l (1 Address:
City State Zip Code City State Zip Code
State Zip Code
WA State Contractor License #: �L� C 2V2C_3Contact: 44"/;-)
PERMIT /BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2 "" .FLOOR SQ. FTG:
UNPIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECK/COV. 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 OR ON -SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Width:
Manufacturer:
Length:
Year:
Pit Set:
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
Phone:
State
Fax:
Zip
City
State Zip
SPECIAL INSPECTIONS
n BOLTING ❑ CONCRETE [ I REINFORCEMENT ❑ WELDING
Firm Name:
Phone:
Inspector(s):
Fax:
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 resu jing developme t rights granted by any issued permit inur to the property owner. /,,
Print Name c /` / Signature (Zr/,,—)
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN #:
Authorized Signature: