2004, 08-27 Permit App: BLD-04-07501 Pole BldgSpo'kan
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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: 3 9.2 .47Fecy
Assessor's Tax Parcel Number(s): •
Legal Description: L 7. s --,D - / a — 3
PERMIT DESCRIPTION: • t /c` 2104
Building Permit D Change in Use ❑ Grading
Relocation ❑ Tenant Improvement ❑ Fire Safety
❑ Manufactured Home
❑ Other
OWNER/APPLICANT INFORMATION
Owner: a2i s f /o,c,c;c //4E
Phone: 70/ - 23y0 Fax: •
Address: /.3sz s eG-1.41
SPn bui W I4 .moo. 99,204.
City / State
Zip Code
0 Contractor: FiPrif- /2:71e ,1s/
Phone: 98/- SG y7 Fax: 2s-3- SBY.
Address: %iox .0 7 . •
9 fa ' A /ls c�T 5'9 a 24.
City r State Zip Code
0 Applicant: `D2Ftin
WA State Contractor License #: tq/r7 e '.evSe4
Phone: Fax:
Address:
City . State Zip Code
Architect: LI-) £
Phone: y93- (,/S, Fax: yQ ,E(- 4.sa Z
Address: zYi3 t. coi Cocic
SP0A. ivE L.0 A .972a3
City • • State Zip Code
Contact: /a.v; - Y7
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK 9 ,c -A:
DIMENSIONS:
3vX q 8' • .
# OF STORIES:. .
MAIN FLOOR TO SQ. FTG:
/Y510
2 FLOOR SQ. FTG:
UNFII4 BASEMENT SO. FTG:
. FINISHED BASEMENT SQ. FTG:
GARAGE SQ: FTG: •
• DECKICOV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONDUCTION PE: .
• f'as71 ir1E
HEAT SOURCE:
.# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT: ' 00
ZD/ .5-S-0 • • -
30% SLOPES ON PROPERTY
I •
SEWER OR ON-SITE SEPTIC
SYSTEM? CI -7114
MANUFACTURED HOME
Width.;
Manufacturer: .
Length:
Year:
Pit Set:
• RELOCATION
. Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm:
Tent:
Fireworks Display: Blasting:
Valuation: Above/Underground Storage Tank Size:
Paint Booth:
Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone: Fax:
Inspector:
Address:
City State
Phone: Fax:
Zip.
City
State .
. Zip
SPECIAL INSPECTIONS
❑ BOLTING
Firm Name:
0 CONCRETE
❑ REINFORCEMENT
Phone:
Inspector(s):
F
•
❑ -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 isiwill 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.Spbkane 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 0 Check ❑ Mastercard . 0 VISA 0 Other
• Bankcard #: Expires:VIN#:
Authorized Signature:
This she plan is ung su nitlad for the purpose of
obtaining a bung permit and is ss and correct
representation of. the propo$M. AN known property
Nnes/tame nsions, curb fins; *whites and
have been ideMilied. Also imaceted ars
bodies of waw
3 `/..?0 5. 144er-c.Y C- ,
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