2005, 08-08 Permit App: 05002788 SidingSlane
Milley
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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) 688-00 %
31'
REQUIRED SITE INFORMATION
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Street Address: /s---(/ S. Sar -n.3
I? Cje t z% S( & V6111 I , wi1- eigO 1
Assessor's Tax Parcel Number(s):
Legal Description: /4e> JA1,1 i 4/ / ow«.-- (,16,21
PERMIT DESCRIPTION: 7/dce vi z -e?t"5C
® Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
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[� Owner. J i r,-, Cedp/r ❑
Phone: qz�-aS'gi Fax: 012.7-66-7
Address: r Si I S 1,,i,r
Von l L wet- `131
Citk pate Zip Code
❑ Contractor: ❑
Phone: Fax:
Address:
City
State Zip Code
• WA State Contractor License #:
Spokane Valley Bus. Liscense #:
Applicant:
Phone: Fax:
Address:
City State
Architect:
Phone:
Zip Code
Address:
Fax:
City
Contact:
Contact:
State Zp Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2"L 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 PF PROJECT:
' 33-00 -cri
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
=ire Sprinkler. # of Heads: Fire Alarm: Paint Booth:
rent: Fireworks Display: Blasting: Date/Time:
Valuation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
plans Examiner.
kddress:
Phone: Fax:
City State Zip
nspector. Phone: Fax:
kddress:
City
State Zip
SPECIAL INSPECTIONS
] BOLTING ❑ CONCRETE
❑ REINFORCEMENT ❑ WELDING
=irm Name: Phone:
nspector(s):
Fax:
)ISCLAIMER
The 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
property 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.
Zeferenced 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.
>wnership of resulting development rights granted by any issued permit inure to the property owner.
print Name Jqyyjsz,; C- I_ Signature
/lethod of Payment: (Faxed permit applications will only be accepted with major bankcard)
Cash 0 Check
tankcard #:
authorized Signature:
0 Mastercard
❑ VISA
Expires:
VIN#:
0 Other