2004, 06-08 Permit App: BLD-04-04527 Pole BldgSjiOhne
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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) 688-0037
REQUIRED SITE INFORMATION
Street Address: 1311C , G C LATstt,E sijt,yrt,e
Assessor's Tax Parcel Number(s): . ► 4 CS
Legal Description:
PERMIT DESCRIPTION: %\', -�\M
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Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner:
Phone: Fax:
Address: 1114-, F— C�t,rtrt 1
11..1.1s \.tp 1c,
City State Zip Code
❑ Contractor: 1?__S
Phone: GZ4),,o o°1 Fax: `�aL-\-\>\c)
Address: ci-LSCi{ 5.
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City t State I Zip Code
WA State Contractor License #:
Applicant: ac-,kc,r1_
Phone: ,5`)(9-29-,6 \ Fax: cr)ti-rv- )
Address:
jn \C UN I k \,J c i i r)
City Stat Zip Code
Architect:
Phone: Fax:
Address:
City
Contact:
ALAT1Pnn
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SO. FTG:
2"" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE: '
'C h\T \-s J -i k ii?„.._
HEAT SOURCE: .
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
0, t 00 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
Firm Name:
❑ REINFORCEMENT
Phone:
Inspector(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)
❑ Cash ❑ Check ❑ Mastercard
Bankcard #:
Authorized Signature:
❑ VISA
Expires:
VIN#:
❑ Other
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This site Alan Is being submitted fOr the purpose of
obtaining a buNNig Mp1if and is a trot and correct
representation of she pipeful.
AN hoes/dimensions. . curb kande property
have and easements
bodiesonm . Aleed e! wetlands,
,� areas.
Signed:
Dale:
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