2004, 06-16 Permit App: BLD-04-04622 PatioSpo ane
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:
t 24 i4. 6eAb‘?
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: /4/ '‚/'t'4 7450
Building Permit _ ❑ Change in Use ❑ Grading �❑ Manufactured Home
Relocation ❑ Tenant Improvement ❑ Fire Safety _'} lOther
\CQ
OWNER/APPLICANT INFORMATION
❑ Owner: M CAZAko4-
Phone: '}k,7 - 053kFax:
Address:
670C.,o04-EIA3*
City
State Zip Code
❑ Contractor:-PCZDPE aO'CS
Phone: 4.68-115ti Fax: 440b -07A0
Address:
City
State
Zip Code
❑ Applicant: ZtE_K_ ‘boW s
Phone: fit%1150 Fa 44:4. -OZt
Address: R. 1452.5 1 P; b-lus`S
Mi -P1/443 ctflO LI
City State Zip Code
Architect:
Phone:
Address:
Fax:
City
State
WA State Contractor License #: l-(cOt s 0 g? 1C Contact: . .. tZ2YG.bOc,.) )-k mkt.,
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: f/D / 6 -.e
DIMENSIONS- %7 / X7 fc/ /
i
# OF STORIES: 1
MAIN FLOOR TO SQ. FTG
2N0 FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG _
FINISHED BASEMENT SJ,1, FTG:
GARAGE SQ. FTG: - �_
,
DE COV. ATS. FJG:
Cf
V
OCCUPANCY GROUP:
CONSTRUCTION TYPE: iair Pt
HEAT SOURCE: �) n
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS,SUURFAGEE AREA:
/ /f / (7
0
COST OF PROJECTe,L
ICD
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE EPTIC
SYSTEM? $
0
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:
City
Inspector: Phone:
Address:
State
Fax:
Zip
City
State
Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
❑ REINFORCEMENT
Firm Name: Phone: Fax:
Inspector(s):
❑ 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 /6 AK tt0W i4r r -L Sig
erty owner.
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard , ❑ VISA ❑ Other
Bankcard #:
Authorized Signature:
Expires:
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