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2004, 05-21 Permit App: BLD-04-04415 Garagesij6&. 400Valley 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: rid.") /thrill 'gess'; Assessor's Tax Parcel Number(s): Legal Description: PERMIT DESCRIPTION: �I) LE (C(? sl Ms Building Permit Relocation ❑ Change in Use ❑ Grading ❑ Manufactured Home ❑ Tenant Improvement ❑ Fire Safety ❑ Other OWNER/APPLICANT INFORMATION Owner C_Zf1ck CL; r\ Phone: 9,� n'0gs Fax: e.SS i E Address: j q; 0 W wax State elziz Zip Code ❑ Contractor: Phone: Fax: Address: City State WA State Contractor License #: Zip Code Applicant: Cfea( G1 C Li ;lc Phone: CO .D(,-7,RJ Fax: Add res : 1Qa0 14 da&SStC o 1641 1( CICtZ1Z C' State Zip Code Architect: Z (aa Li Phone: qz2- igt54 1 Fax: P�ddriess: �oZ nrat It ��77 T State Zip Cod Contact: PERMIT/BUILDING INFORMATION HEIGHT TO PEAK: g rA__ DIMENSIQF4Si 1 x i # OF STORIES: Q �e" MAIN FLOOR T1 1S�TO _.2. FTG: 1 Z.. 2 ° FLOOR S(7:124 UNFIN BASEMENT SQ. FTG: A FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: I t Sa DECK/COV. PATIO SQ. FTG: OCCUPANCY GROUP: CONSTRUCTION TYPE: Pot. F HEAT SOURCE: # OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA: COST OF PROJECT: risi ce 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC SYSTEM? S% is 9 R MANUFACTURED HOME Width: Manufacturer: Length: Year: Pit Set: RELOCATION Previous Address: Proposed Use: FIRE SAFETY Fire Sprinkler: Tent: # of Heads: Fire Alarm: Paint Booth: Fireworks Display: Blasting: Date/Time: Valuation: Above/Underground Storage Tank Size: WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE Plans Examiner: Address: Phone: Fax: aty Inspector: Phone: Address: State Fax: Zip City State Zip SPECIAL INSPECTIONS ❑ BOLTING ❑ CONCRETE Firm Name: ❑ REINFORCEMENT Phone: Inspector(s): Fax: ❑ 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 inur Print Name Co FO1TCt l R e.t t r\T Signature o the property owner. 7 ` Method of Payment: (Faxed permit applications will only be accepted with major bankcard) ❑ Cash pi Check ❑ Mastercard ❑ VISA ❑ Other Bankcard #: Authorized Signature: Expires: VIN#: jO(\/o Rd.� � d Ae 03M31A311 si.N3p10103 JNOth SAtM MON 13NO2 Sltioav so sodots duels 'j=' to sa!poq PAW only 'Pa!4!1 ueaq aney pHs somptupt 'Seim qmo ' s o!suew!p/scut! APg4018 taw* py psodwd eq jo uo!leluaseIdei m pull len • t+! Pow *wed 8V penW B 6u u!@lgo io asodj d alit ni pMgsi 6u q sl weld eas s!ui • u C.: 3 7 0 ' THE/LE-ME0 BA CO triLH12 t+4e,'7 rrtlbLH Y&DE22 - izc,ut. .:�,�1rr.;; 4 41Gala dlgK�' BLeaT� p;'.•q i.4 M , . :roce. alARC T. h: l:vs4,nl:c:y JY t,x ba r 1 2' KY til}iir 12 i ps4re sividngsq COW*