2004, 04-15 Permit App: BLD-04-04079 Siding, Sheetrock, Vent FansSpokane
�Ualley
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: S6(Y E. t1k(•i--01 �"�
Assessor's Tax Parcel Number(s): \l
Legal Description:
PERMIT DESCRIPTION:
❑ Building Permit ❑ Change in Use ❑ Grading ❑
Manufactured ome
❑ Relocation j Tenant Improvement ❑ Fire Safety ❑ Other
Ft ThI4 &He W4:9n-
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OWNER/APPLICANT INFORMATION
❑ Owner: 0-,-\,‘ J . Po(v 5 ❑ Applicant:
Phone: 9a920g7 Fax: Phone: Fax:
Address: I ;', IDR L• 6 i bb5 Address:
ter Wc. 49023
City State Zip Code City State Zip Code
❑ Contractor: ()outer- (c>,\-.t-aclor ❑ Architect:
Phone: Fax: Phone: Fax:
Address:
Address:
City
State Zip Code City -
Contact:
WA State Contractor License #:
State Zip Code
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:
,,'fit oon
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
Width:
it Set:
Manufacturer:
Previous Address: _
Proposed Use:
Fire Sprinkler:
Tent:
Valuation:
Plans Examiner:
Address:
Inspector:
Address:
❑ BOLTING
Firm Name:
Inspector(s):
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 prope owner.
Print Name
AY% ll:av, � , ?Urv) S Signature (AD- IM^^'y
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check E Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature: