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2004, 04-30 Permit App: BLD-04-04237 Siding04 7 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 2a ,E /n19% Assessor's Tax Parcel Number(s): 9 5/ ' y, / az y c/ Legal Description: LeT 40 &dor' 6, N441,.t-a7bN R[)L , rn. 56,t,(pp/ ;544/ PERMIT DESCRIPTION: (i,N4'f S;t/e tknre; (ilding Permit ❑ Change in Use ❑ Grading ❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Manufactured Home ❑ Other OWNER/APPLICANT INFORMATION Owner: D.d=wtN $-cacti Phone50q) 2/ g-3262 Fax: Address: g526 /v/ptiv.. C 64'4 writ 67.9z i L ity State Zip Code ❑ Applicant: Phone: Address: Fax: City State Zip Code ❑ Contractor: LLAv ei occh ❑ Architect: Phone: Fax: Address: Phone: Fax: Address: City State WA State Contractor License #: Zip Code City State Zip Code Contact: 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 OFg.pROJECTT D "' L500 t 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC SYSTEM? MANUFACTURED HOME Width: Manufacturer: Length: Year: 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: Address: Zip City State Zip SPECIAL INSPECTIONS ❑ BOLTING ❑ CONCRETE ❑ REINFORCEMENT Firm Name: Phone: I nspector(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: