2005, 05-11 Permit App: 05001516 Carport*lane
.00Valley
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: 100 .Z 0 £ M sr, o n
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
(S Building Permit
9 Relocation
3-3
9 Change in Use 9 Grading
❑ Tenant Improvement 9 Fire Safety
1/,
9 Manufactured Home
9 Other
OWNER/APPLICANT INFORMATION
❑ Owner. I4r. nc.\
Phone: r/-7 -?r Fax:
Address: rooao c' "7..rs•o.-. A
�k�e.vNly 4-
ty State
❑ Contractor: c,.,,...R
44 201 --
Zip Code
Phone: Fax:
Address:
City
9 Applicant: SG,c;
Phone: Fax:
Address:
City
State Zip Code
❑ Architect:
Phone: Fax:
Address:
State Zip Code City
State
WA State Contractor License #: Contact:
Spokane Valley Bus. Liscense #: Contact
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:/
I
DIMENSIONS: 3
-22' X
# OF STORIES:
A//
MAIN FLOOR TO SQ. FTG:
2""
N /�" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG: M-
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:DECK/COV.
2�
PATIO SQ. FTG:
y /fr
OCCUPANCY GROUP:l l .
r`
1
CONSTRUCTION TYPE:
HEAT SOURCE:
N /fr
# OF BEDROOMS:
(1)/a"
TOTAL HABITABLE SPACE:
tiles
IMPERVIOUS SURFACE AREA:
Nle
COST OF PROJECT:
t 'j 06 ex-
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM? P fr
MANUFACTURED HOME
Width: /Length: Year:
Manufacturer:
Pit Set: / �� Aga
',9101. boa
RELOCATION
LS l i 0
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
Address:
Inspector:
Address:
Phone:
Fax:
City
Phone:
State
Fax:
Zip
City
State
Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
Firm Name:
❑ 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 of reing development rights granted by any issued permit )n re to the property owner.
i
Print Name
Signature / 1 / A .. )
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
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representation of the proposal. All known property
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lines/dimensi curb knee. sbuctures and easernenM
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Signed: .44one/if areas.'
Date:
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