2004, 06-24 Permit App: BLD-04-04705 Pole Building1O9
*km
_Valley
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: 1/ 7 / E. (5eyer-e- r -e5 S 0
h6Assessor's Tax Parcel Number(s):
Legal Description:
40- PERMIT DESCRIPTION:
4 Building Permit
Relocation
for, I) cc4 err(
LI Change in Use E Grading
El Tenant Improvement E Fire Safety
0 Manufactured Home
0 Other
OWNER/APPLICANT INFORMATION
Owner: ...Tit.,es . /41 c tie r Applicant:
Phone: Fax: k/s---55-0 <57( Phone:
Address: I3cSO- Address:
p-(? F17\
Ci
Llkit Hey US -4 5
State Zip Code
Contractor: 6‘..-% N
Phone: Fax:
Address:
City
State
Zip Code
C
Fax:
City
Architect:
Phone:
State Zip Code
Fax:
Address:
City
State
WA State Contractor License #: Contact:
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:7
.,70 /
# OF STORIES:
'MAIN FLOOR TO SQ. FTG:
N h.00\
2 FWOR 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:
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Width:
Length: Year: Pit Set:
Manufacturer:
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
1
Plans Examiner: Phone: Fax:
Address:
City State
Inspector: Phone: Fax:
Address:
Zip
City
State
Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
Firm Name:
El REINFORCEMENT
Phone:
I nspector(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 inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
0 Cash 0 Check 0 Mastercard ❑ VISA 0 Other
Bankcard #: Expires: VIN#:
Authorized Signature:
Sikikane
Valley
117U7ESprague Avo.Suite 1OU
Spokane Valley, WA 99206
Job Address: 11721 E BOONE AVE
SPOKANE WA 99212
Description: 30 X 40 POLE BUILDING
Subdivision:
Owner:
Applicant:
Address:
Contractor:
Address:
MCGNERN.JAMES R&ELENA S
MCGIVERN, JAMES R & ELENA S
182 GORDEN HOMES B
COLV|LLE.VVA 99114
ACCESSORY BUILDING
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THIS IS NOT A PERMIT
Penalties wifl be assessed for
commencing work without a permit
Application #: BLD -04-04705
Applied:
Issued:
Expires:
Lot: Blk: Parcel No: 45161.0634
Phone: (509) 880-6543
Phone:
Lic No:
Zoning:
06/24/2004
12/21/2004
General Information:
VALUATION
BUILDING HELGHT TO PEAK
DIMENSIONS
# OF STORIES
FRONT SETBACK
REAR SETBACK
LEFT SETBACK
RIGHT SETBACK
OCCUPANCY GROUP
CONSTRUCTION TYPE
STRUCTURES ON PROPERTY
SERVED BY SEPTIC SYSTEM
WELLS LOCATED ON PROPERTY
22800
19
30 X 40
150+
100+
11
50+
u'1
5-n
3
yes
no
Fees:
BASIC PERMIT FEE
WSBCC SURCHARGE
Total Calculated:
Deposits/Receipts:
Total Due:
363.25
4.50
367.75
0.00
367.75
-CITY SPOKANE VALLEY
APPROVED FOR SUBMITTAL
/ Date
Building
ing
THIS IS NOT A RECEIPT
1
,c )i
(.) v
% v-1 L-.7
;
/
ADDRESS
ZONE
ROAD
Z
EITC S
REVIEWED
Malibu:din is being submitted for the purpose of
obtaining a building permit and is a true and correct
representation of the proposal. Ail known property
lines/dimensions, curb lines, shut:tutu and easements
have been identified. Also indicated are wetlands.
bodies of water, steep stopetsor) other crillcal areas.
Signed: •