2004, 07-07 Permit App: BLD-04-07032 MH•••"44.,.
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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: %‘,5-0 E _ %a v -1,1°,41-1-o‘,)
Assessor's Tax Parcel Number(s): L"(5 t c61, ( c3 5
Legal Description: 1 tGt tr rt v-3 j4 S 4o ttt-l-c ti L-f6LI
PERMIT DESCRIPTION: c
❑ Building Permit
❑ Relocation
Q
❑ Change in Use 0 Grading .Manufactured Home
❑ Tenant Improvement 0 Fire Safety 0 Other
OWNER/APPLICANT INFORMATION
❑ Owner: 00v �cLav� S
y ❑ Applicant:
Phone: 'Fax: Phone: Fax:
Address: Address:
City
O Contractor:
Phone: 534-r
Address: , 05 , ,.� Q Address:
tylo fca V� e L.1/ ' ' g2_1
State Zip Code City L_AState Zip Code
WA State Contractor LC� l
is , (,q ntact: 2._
State
Zip Code City State Zip Code
0 Architect:
Phone: Fax:
554-1-432_7
PERMIT/BUILDING INFORMATION •
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. 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:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Width: 7 7 Length: CIO
Manufacturer: Foe i vOo34
Year: Li 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
Inspector: Phone: Fax:
Add ress:
Zip
City
State
Zip
SPECIAL INSPECTIONS
D 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 ❑ .VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
ct.‘ev‘ vt3)-(.7 5-01/1/3
N�
for the purpose of
is being submitted and Wry
This obtaining
Plan permit and is a Mat t
representation a otnt e I All known Pfd
lines imeini the PresOtru eaeMEtants
lines:dimensions. curb lines. structures and
t1AVt1 ode tied. AtsO ,
kindles e t water, s p
al Signed:
Date:
ADDRESS
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Punt • 18LO-04-07032
Petal TypeJMANUFACTURED HOME
1 crap 1 Action Code 1 Action Desaiption
Address 8718 E HARRINGTON AVE
SPOKANE WA 99202
1 Completion Dare 1 Ceaplete Code
11 IPemsi Comer
12 1Buicing
1Routed
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14 Engineering
15
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6 'Spokane Regional Heater Dis
Sewer
17
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1a Istoermaler 'Routed
19 IWA tabor i Industry 1Raied
110 'DMwReview }Routed
11 }PaenlCounter 'Routed
112 IBuidrg Inspections 'Wald 9
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112 00401 (SETBACKS 1
112 100402 'BLOCKING '09/14/2004 021255 PM
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112 1 !FINAL
1 Group Tile'Bulking Inspection
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