2004, 04-02 Permit App: BLD-04-03958 Finish BasementSpokane
Valley
l
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: !I0 St 4/ewer
Assessor's Tax Parcel Number(s):
Legal Description:
CIr\q(e tarrJ
ur tT 41rr&ckd Seranct
PERMIT DESCRIPTION:
,Building Permit
Relocation
❑ Change in Use IP1 Grading
Tenant Improvement ❑ Fire Safety ❑ Other
❑ Manufactured Home
OWNER/APPLICANT INFORMATION
DV Owner: (,t -Nay -it Car/Sova
Phone:
Address: ICc:C1 S i N€4..xr
SOoR Oath/ wee gyn3�
Cid State Zip (Code City
V Contractor: Covnersioa-e C'onct ❑ Architect:
Phone: 4.03c lek) Fax: Sce.r&e Phone: Fax:
Address: 20 Qo>c '(3/, Address:
res
t.v A 99aoV
City State Zip Co
Fax: ----
Applicant:
Phone:
Address:
Fax:
State Zip Code
WA State Contractor License #: f o -npt - 4133 .9
City
Contact:
Card Pol I er
State
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG: - `
i
-2"u FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
t
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:T _�
(�)
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTIJ1 ED`HOME
Width:
Manufacturer:
Length: Year: Pit Set:
RELOCATION
Previous Address:
Proposed Use:
r -
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
Inspector: Phone:
Address:
State
Fax:
Zip
City
'State
Zip
SPECIAL INSPECTIONS
n BOLTING ❑ CONCRETE
Li REINFORCEMENT
Firm Name: Phone: Fax:
Inspector(s):
❑ WELDING
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: :1)_11 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 r ulting opment rights granted by any issued permit
Print Name l/et Ji C- Signature
nature
ure to
e
rty owner.
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #:
Authorized Signature:
Expires:
VIN#:
IV/
EXHAUST FANS
100 CFM kitchen
50 CFM bathrooms
& 'laundry
p)ui'
2
1.611v1 Cent
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