2005, 04-25 Permit App: 05001311 Pole BldguttaHLUle
.0•017alley
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: '2109 5.. 8•al%toov- Rlyct
Assessor's Tax Parcel Number(s): 'Lf29/ 9(oQZ
Legal Description: [Di' -C 1tu 1'10e --s '? „& (lied ev .t ; l (s �l.4rvs,Vtk & h. r5 0*r 9L
PERMIT DESCRIPTION: 6n5-frticS find. Psrn 30t x.
Building Permit
Relocation
❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner:`on-os 4. Mann s
Phone: 89 z -.It)/ Fax:
❑ Applicant:
Phone: Fax:
Address: 2-109 -5. Ca(&1‘31-- Address:
k-
C State Zip Code City State Zip Code
Contractor:
Phone:
Address:
Fax:
City
❑ Architect:
Phone: Fax:
Address:
State Zip Code City
WA State Contractor License #:
Contact:
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS: 1 30 X6 i
# OF STORIES: i
MAIN FLOOR.TO SQ. FTG; 1086
,"".FLOOR SQ. FTG:
UNFIN 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:8666-W
'i 8 t 66 - W ..
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:. -
Tent
Fireworks Display: t i Blasting:
Valuation: Above/Underground Storage Tank Size:
Paint Booth:
Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
24. Fax:
City State
Inspector: Phone: Fax:
Address:
Zip
City
State
zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
Firm Name:
❑ REINFORCEMENT
Phone:
Fax:
❑ WELDING
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 i to the pro erty owner.
Print Name llitfl yy)q-c fi QctVI44 Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check E1Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
Project Number: 05001311 Inv: /
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 04/25/2005 Page 1 of 2
Project Information:
Permit Use: 30 X 36 POLE BARN
Setbacks: Front 127 Left: 62 Right: 5 Rear: 48
Site Information:
Plat Key: 000382 Name: CHESTER HILLS ADD
Contact: ADAMS, THOMAS H
Address: 2109 S BALFOUR BLV
C - S - Z: SPOKANE VALLEY, WA 99206
Phone: (509) 892-0209
Group Name:
Project Name:
District: Sout
Parcel Number: 45291.0605
Block: Lot:
SiteAddress: 2109 S BALFOUR BLV
Location:: CSV
Zoning: UNKN Unknown
Water District:
Area: .00 Acres
Width: 0
Nbr of Bldgs: 0 Nbr of Dwellings: 1
Review Information:
Owner: Name: ADAMS, THOMAS H
Address: 2109 S BALFOUR BLV
SPOKANE VALLEY, WA 99206
Hold: ❑
Depth: 0 Right Of Way (ft): 0
Review
Site Plan Review
Released By:
Plan Review
Permits:
Released By:
Operator: K_C Printed By: K_C Print Date: 04/25/2005
Project Number: 05001311 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 04/25/2005 Page 2 of 2
Contractor: OWNER
Group: U-1 Type: VB
Total Area 1080
Building Height 18
Stories 1
Description
BARN
Building Permit
Firm: OWNER
Phone: (000) 000-0000
Building Characteristics
Grp Type Notes
U-1 VB
Item Description
RESIDENTIAL PERMIT FEE
STATE SURCHARGE
Notes:
This Application: Total Project:
Sq Ft Valuation Su Ft Valuation
1,080 $20,520.00 1,080 $20,520.00
Totals: 1,080 $20,520.00 1,080 $20,520.00
Units Unit Desc
1 SELECT
1 SELECT
Permit Total Fees:
Fee Amount
$335.25
$4.50
8339.75
Payment Summary:
Pennit Type
Building Permit
Fee Amount Invoice Amount
$339.75 $339.75
Amount Paid
Amount Owing
$0.00 $339.75
$339.75 $339.75 $0.00 $339.75
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance ofa permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: K_C Printed By: K_C
Print Date: 04/25/2005
fhik ills BI19 IIOM 4t1A�i(f> 2 Ioi i�ie �irpeii of
bbiainih j €1 ANIIW!1 PKt^! ?iu; s a true and oenset
iepresbntaiiu n 8t r, Pc, � ntl known property
cu Iingt
Imeslblinensnv:•:. ... � ..,, •..asements
have been weutiiie:: pis. ;. il,6tds,
bodies pl-. ater, p slopes w ou,„•, , ,in:,tl •iieas.
Front Street
2109 S. Balfour Blvd.