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#:
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