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2005, 05-09 Permit App: 05001467 Demolish GarageSY�kane #Vailey 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 1 Street Address: Assessor's Tax Parcel Number(s): Legal Description: PERMIT DESCRIPTION: () .e wk.. • _ A/ , n v‘ ` 1 ❑ Building Permit ❑ Change in Use ❑ Grading ❑Manufactured Home ❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other OWNER/APPLICANT INFORMATION ❑ Owner. )4\ 1,� .-oIt`e r 0 Applicant:.�e v �,�, o s c Phone. Fax: Phone: c� t u g-45gs-45 Fax: Address: 13 _A/vvec �r: �.. Address: d t z .4 . S�o, u9 _ G`ot�t �o fes 41° City State Zip Code City V Sta a Zip e ❑ Contractor: Phone: Fax: Address: City ❑ Architect: Phone: Fax: Address: State Zip Code City Contact: WA State Contractor License #: State Zip Code Spokane Valley Bus. Liscense #: 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/GOV. 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: Manufacturer: Length: Year: Pit Set: RELOCATION Previous Address: Proposed Use: FIRE SAFETY Fire Sprinkler: # of Heads: Fire Alarm: Tent: Valuation: Above/Underground Storage Tank Size: Paint Booth: Fireworks Display: Blasting: Date/Time: WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE Plans Examiner: Address: Phone: Fax: City State Inspector: Phone: Fax: Address: Zip City State Zip SPECIAL INSPECTIONS El BOLTING ❑ CONCRETE Firm Name: 0 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 ofresultingdevelopment rights granted by any issued permit inure to the property owner. Print Name .A, y� ovr-44r t7 Signature 0 \j e L Method of Payment: (Faxed permit applications will only be accepted with major bankcard) ❑ Cash © Check Bankcard #: Authorized Signature: ., 0 Mastercard 0 VISA 0 Other Expires: VIN#: