2005, 09-23 Permit App: 05003499 PoolT T �
1eyi,SiMane ,/
A
4.0%
vD 0`T t -f
5)
BUILDING PERMIT APPLICATION WORKSHEET
ly of Spokane Valley Community Development Department
. Building Division
_ 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Ptrime: (509) 688-0036; Fax: (509) 688-0037
fq
REQUIRED4g 7,,�y ORMATION
Street Address:
356 q 3 Lia re_ tf
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: r) --)r), (3 RfOitaiiE
❑ Building Permit D Change in Use D Grading 0 Manufactured Home
0 Relocation ❑ Tenant Improvement ❑ Fire Safety XcOther
OWNER/APPLICANT INFORMATION
❑ Owner: / ev7ee.. LaVot-e
Phone: 9,?3 -- 3y 70Fax:
(A,dd�ress: s ,U9 QST. , Air?
ttc.
` o V� �1 State ( i - %)-0Stale Zip Code
City Zip Code City
Contractor: /61-. / C',p,- vec,0 0 ,:,.-,trac ❑ Architect:
/ \ Phone: 3 zs - 3o sz/ Fax: Phone: Fax:
0 Applicant:
Phone: Fax:
Address:
Address: Co (00 N • M0 v /Lea
Sp%csrn-e 1A -)q1 99Z--'3
City State Zip Code
Address:
City State
WA State Contractor License #: rqr C C`"/'/e LU9//// Contact: par/
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2ND 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°/
6'i DDD -
SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Width: Length: Year: Pit Set:
Manufacturer:
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: Phone: Fax:
Address:
City State
Inspector: Phone: Fax:
Address:
City
State
Zip
Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
Firm Name:
0 REINFORCEMENT
Phone:
I nspector(s):
Fax:
0 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.
Ownershipting development rights granted by any issued(permit inur� to the property owner.
Print Name oC t t 4,:b„, 4- Signature _ ;c,-,y''—
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash 0 Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #:
Authorized Signature:
Expires:
VIN#:
INc t3EC-TiON r2EPOt2T
Arc 12 E : fat,. .55640 4 cot.rn2Acro a : NAW161 KIS
u.h. pa.r2M1T N°• : 0'l0
CA.ot-1 vy...)uo : Yet/ 0 ►W
UPb1'J1VIeoto},1 NAME 4 Aor)mc.»-i ; I`ftlalLo WT
UPEt2AT02 /, Nc,pEC'f CO2 : ,5 Li
TYPE% cv1ZE OF PIPE
1 t..16, P. ( &TE . D1►84-
i)L4.)CKN°•:
LoT ?/3LeZ
DATE RL'Ct-1ECKErJ F'vt2 CAc1•1 P Q JO t2ELEAc/E '
Vitig7r
5r�
LpiZ 1,TA
to1CTU121AL 17IIGt2AM
NUal- t -J
A r2 r2Ow
um= b15MJ5q uumnbulimR
PEWIT IMA 070
ming Sn 35oD Li5c2EITA Pct. INSP. DOE 9 • • 84
WT 7 m; 1 ADD1T 1S MII7IL0ME 3. 92, ADoi4.
33SiJ-Z/o7.
Location of *Tee" or Tap
Type of Tap
Type of Side SeverE REVEI25E
,,Type of Building Sever
Depth at Property Line
SIS:
NVOIZZ e : JAGK 1••IANt I N5
NW? W1: ejtu..
iDeld
t3-27 -O7O1
s33(41cY
AY
Co. Utilities Dept.
Phone 456-3600
OR ECZ'A 02. pati` d
TOP o1Fao.
Z'f•
22'
4" P,v.C. /o -3o34
5gtEP�
•
•
1 tEVA'
I SUS
•
?49c '
i
% !///ry
S /
vi c > cr.
Odf NO `'/,0 `
vo
j1
kloi,) 42-
p
/NN / SN,pOSi; '
S
s 4& /O0
S/pA�s Oi�C/�Ps
0,-
/ N
. f ("0 A`
0/ 0„)
doeja 44) 0' ppS
d
A, de P .0". O,� P f
O
c'"/'0 Odf , tz„ cf
de P dpS
dS
0 k 1#711:
sca L k', e
/ G)
b'o T s. Lo�m
e4AC.KJby,/M,4