2004, 11-03 Permit App: 04009011 Basment FinsishSpdanffle.-,,;OoValley
Street Address: 391
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
S J0hn56n-
Assessor's Tax Parcel Number(s):
Legal Description.-
PERMIT
escription:
PERMIT DESCRIPTION:
❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: �;( �)�hs
Phone: cja(o -31 Y(2 Fax:
Address: 3cl l (o <5 lc) h r z, , S,
SQC)Lb� W A °t a2L6
City State Zip Code
❑ Contractor:
Phone: Fax:
Address:
City State Zip Code
WA State Contractor License #:
❑ Applicant: S0.1v�-k
Phone: Fax:
Address:
City State Zip Code
❑ Architect:
Phone:
Address:
City
Contact:
Fax:
State Zip Code
PERMIT/BUILDING INFORMATION ii
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2 Nu 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?
Width: Length:
Manufacturer:
Previous Address:
Proposed Use:
Fire Sprinkler:
Tent:
Valuation:
MANUFACTURED HOME
Year:
Pit Set:
RELOCATION q
FIRE SAFETY
# of Heads:
Fireworks Display:
Above/Underground
Fire Alarm:
Blasting-
Storage
lasticg:Storage Tank Size:
Paint Booth:
Date/Time-
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE i
Plans Examiner:
Address:
Inspector:
Address:
❑ BOLTING
Firm Name:
I nspector(s):
Phone:
Phone:
City
Fax:
State
Fax:
State
Zip
Zip
SPECIAL INSPECTIONS 11
❑ CONCRETE ❑ REINFORCEMENT
Phone:
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:
Expires:
❑ VISA ❑ Other
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