2005, 08-19 Permit App: 05003023 Siding, WindowsaVaeHey
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division,
:, - 23O2?) 11707 E. Sprague Avenue, Suite 106
S . 1 Spokane Valley, WA 99206
Phone: (509) 683-0036; Fax: (509) 668-0037
REQUIRED SITE INFORMATION
Street Address: /415-0, , rroacji
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: I'Ve,W cbic w,1(10605
Rt$uilding Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
_Owner. C5 h» 1 . be.3 irrcrne ❑ Applicant:
Phone: 9,99-3/s-- Fax: Phone: Fax:
Address: /Sacra E &cad ,4v Address:
5'47 ie Ve// `77;9L(?,
Cid State Zip Code City State Zip Code
0 Contractor: ❑ Architect:
Phone: Fax: Phone: Fax:
Address:
Address:
City State Zip Code City State Zip Code
Contact:
Spokane Valley Bus. Liscense #: Contact:
• WA State Contractor License #:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
214° 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:
•3 OC)
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
JVidth:
Length: Year Pit Set:
Manufacturer.
RELOCATION
Previous Address:
Proposed Use:
=ire Sprinkler. # of Heads: Fire Alarm:
Tent:
Jaluation: Above/Underground Storage Tank Size:
Paint Booth:
Fireworks Display: Blasting: Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner.
address:
Phone: Fax:
City State Zip
nspector. Phone: Fax:
kddress:
City
State Zip
SPECIAL INSPECTIONS
] BOLTING D CONCRETE
❑ REINFORCEMENT ❑ WELDING
=irm Name: Phone:
nspector(s):
Fax:
)1SCLAIMER
-he permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
!welling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
)roperty owner. 3) The signatory is the property owner or has permission to represent the property owner in this
ransaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
eferenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
'ermit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
)wnership of resulting development rights granted by any issued permit inure to the property owner.
'rint Name D—O%� /1'• I 3 >kwP,p
Signature
/'4 a
/lethod of Payment: (Faxed permit applications will only be accepted with major bankcard)
Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Iankcard #: Expires: VIN#:
authorized Signature: