HomeMy WebLinkAbout2007, 02-23 Permit App: 07000531 Safety Inspect ChimneySpokane
Val ley
Community Development
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www.spokanevalley.org
Safety Inspection
Permit Application
PERMIT NUMBER:/
'0831
`'
PERMIT FEE: '1 J
Adult Family Home
ire/Water/Vehicle Damage
Other:
SITE ADDRESS19a (o m G a
ASSESSORS PARCEL NO:
LEGAL DESCRIPTION:
Building Owner:
DIMENSIONS:
# OF STORIES:
Name:id.-Ar 6-eJua.-S &
MAIN FLOOR TO SQ.
FTG:
2N" FLOOR SQ. FTG:
Address: iV yam ft .inle4lL /,'
IMPERVIOUS SURFACE
AREA:
FINISHED BASEMENT
SQ. FTG:
City:U State: All
Zip:�y
66
Phone: 5e,ty, 1,,.6._--q:.-4
1,6- y4 Fax:
Fax:
HEAT SOURCE:
Contact Person
Name:
Phone:
Describe the scope of work in detail:
Contractor:
DIMENSIONS:
# OF STORIES:
Name:
MAIN FLOOR TO SQ.
FTG:
2N" FLOOR SQ. FTG:
Address:
IMPERVIOUS SURFACE
AREA:
FINISHED BASEMENT
SQ. FTG:
City:
State:
Zip:
Phone:
Fax:
HEAT SOURCE:
Contractor Lic No:
Exp Date:
City Business Lic. No:
Cost of Project: $
**The
**
*The followi
, , a- ,ems
MUST be coin fete: (write N/A if not applicable)**********************
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
TOTAL HABITABLE SPACE:
MAIN FLOOR TO SQ.
FTG:
2N" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
IMPERVIOUS SURFACE
AREA:
FINISHED BASEMENT
SQ. FTG:
GARAGE SQ. FTG:
DECKICOV. PATIO SQ. FTG:
30% SLOPES ON
PROPERTY:
# OF BEDROOMS:
CONSTRUCTION TYPE:
HEAT SOURCE:
SEWER OR SEPTIC?
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. 6) Plans or additional information may be required to be submitted, and subsequently approved before
this application can be processed.
Signature >Y7. f ✓ .
Method of Payment:
❑ Cash
Bankcard #:
Authorized Signature:
REVISED 8/25/2005
❑ Check
❑ Mastercard
Expires:
Date a, _a_ c?'l
❑ VISA
VIN#: