2004, 06-10 Permit App: BLD-04-04569 RemodelSikikane
.00•017alley
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: O.? E. (11 I e. fUE LI_
Assessor's Tax Parcel Number(s):
Legal Description:
LMS', .001LA-TvE VALLEY, 1,-0 A 'ic16
PERMIT DESCRIPTION:
❑ Building Permit
❑ Relocation
t; 1.1.(E- rl C N i
❑ Change in Use ❑ Grading
❑ Tenant Improvement ❑ Manufactured Home
P ❑ Fire Safety 0 Other
OWNER/APPLICANT INFORMATION
Owner: (M L.lj l ❑ Applicant:
Phone: Lf6 Lf- 3 Sce; Fax: Phone: Fax:
Address: tect03 E ,ELL( LJ., Address:
icAN VALLL /J A ci'Ro i-6
City State Zip Code City State Zip Code
0 Contractor: 0 w ni
Phone: Fax:
Address:
City State
❑ Architect:
Phone:
Address:
Zip Code City
Fax:
State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
# OF STORIES:
UNFIN BASEMENT SQ. FTG:
DECK/COV. PATIO SQ. FTG:
HEAT SOURCE:
IMPERVIOUS SURFACE AREA:
SEWER OR ON-SITE SEPTIC
SYSTEM?
HEIGHT TO PEAK:
MAIN
DIMENSIONS:
FLOOR TO SQ. FTG:
214" FLOOR SQ. FTG:
FINISHED BASEMENT SQ. FTG:
(023 S1 -.Sq -
GARAGE SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
# OF BEDROOMS: •
TOTAL HABITABLE. SPACE:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
# OF STORIES:
UNFIN BASEMENT SQ. FTG:
DECK/COV. PATIO SQ. FTG:
HEAT SOURCE:
IMPERVIOUS SURFACE AREA:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Width:
Length: Year:
Manufacturer:
Pit Set:
RELOCATION
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:
Phone:
Fax:
City
Inspector: Phone:
Address:
State
Fax:
Zip
City
State
Zip
SPECIAL INSPECTIONS
D 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 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)
0 Cash ❑ Check 0 Mastercard ❑ .VISA 0 Other
Bankcard #: Expires: VIN#:
Authorized Signature: