2005, 03-24 Permit App: 05000901 Demo" 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: /3/7 ' V Boe3c46
Assessor's Tax Parcel Number(s): /s/(tea. 0,575
Legal Description: Q, W C'Gia 4e 0C 5CC1J C'1
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ay .4 GJi//t f4Ierci cLea Sid Kane_ fa,
PERMIT DESCRIPTION: e�ol Vic9,
oV' aUx a5- -oo� ii e / Pble B'ai/4 Vor pr vude Ong
Building Permit El Change in Use (l Grading (l Manufacturedome
❑ Relocation El Tenant Improvement ❑ Fire Safety 14 Other OlevvIo�V;o„
OWNER/APPLICANT INFORMATION
O er: E// 4�1� ❑ Applicant: il/ �
e-3 / )- - - . 0 -50- a Phone: Fax:
resss: /3 / ? /1 'c - v'i3 Address:
p64:a-ne' W ct. `75.2c
City State Zip Code City State Zip Code
El Contractor: ❑ Architect:
Phone: / /41I x: Phone: Fax:
Address:
Address:
City State Zip Code City State Zip Code
WA State Contractor License #:
Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR.TO SQ.. FTG: .
•2"1 -.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:
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACDJRED HOME
Width: Length: Year:
Manufacturer:
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:
Phone: Fax:
City State Zip
Inspector: Phone: Fax:
Address:
City
State Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
Firm Name:
REINFORCEMENT ❑ WELDING
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 resulting development rights granted by any issued permit inure to the property owner.
Print Name 10; 1/
Signature /
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
Check ❑ Mastercard
❑ Cash
Bankcard #:
Authorized Signature:
1_3 -
❑ VISA ❑ Other
Expires: VIN#: