2004, 05-13 Permit App: BLD-04-04341 Deck, Roof CoverSpo'lane
4,00Valley
' 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: 9 7 S. poi - k Rcl . Spkn,
)1 i1.,4`)
Assessor's Tax Parcel Number(s): 7 5 / q 3 . b t/
Legal Description:
ae t/ -1--((1�-
100: 411 dscl
PERMIT DESCRIPTION: 1 Lc adifl ?rvl a N et a ()cub/
Building Permit
[J Relocation
❑ Change in Use D Grading ❑ Manufactured Home
❑ Tenant Improvement D Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Owner: men 3 Ked i I Ward k/& -
Phone: Slfl-wp,-ptoiS Fax: —
Address: dal SOud-k Rol Ra •
ok l.1) Pc 990ta
State Zip Code
❑ Applicant:
Phone:
Address:
Fa'
City
0 Contractor: ❑ Architect:
Phone: Fax: Phone: Fax:
Address:
State
p Code
City State Zip Code
WA State Contractor License #:
Address:
City State Zip Code
Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO -SQ. FTG:
flu FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
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:
30% SLOPES ON PROPERTY:
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: Phone:
Address:
Fax:
City State
Inspector: Phone: Fax:
Address:
Zip
City
State
Zip
SPECIAL INSPECTIONS
❑ BOLTING 0 CONCRETE
Firm Name:
0 REINFORCEMENT
Phone:
Inspector(s):
Fax:
0 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)
El Cash )Check 0 Mastercard ❑ VISA D Other
Bankcard #: Expires: VIN#:
Authorized Signature:
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DEPARTMENT OF BUILDING AND PLANNING
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address: CI - Lt V� r GLx k l�C� . ��(,� t . \ . (} C!
Assessor's Tax Parcel Number(s): 1V F� `l
Legal Description: 13 e U e v } (.1 v- i CS L1
(046 i -
Project Description: e c k. a.c:tc i
C�1
g Building Permit
❑ Change in Use
❑ Grading
❑ Manufactured Home Permit
❑ Relocation
❑ Sign
❑ Tenant (New/Change)
❑ Other
Department Use Carl
❑ Applicant: l/�,I
1V
<C.- C1
I��j� "'� Phone:
I l�
( Fax:
Mailing Address:,Mailing
q.. u -t-1', Pia v k Pc ,
Address:
-
Ci State, Zip
/�*y �j
C)i�l(�rQC?
�� 1 I
City, State, Zip
bate[ Dfstnct/Fucvgyvr:.
v
,
Sewe,Dis ricr/Ittt[veyor i
Road widt`it
Mailing address
Setbacks ;-
Fmnt
y
�;
Right:
u+
✓ r
grEE
School 17istnca
::
pith
y
Zoning
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OWNER/APPLICANT INFORMATION
Ei Indicate mho should be contacted repardinp this broiect
El Owner. A ) 1 /^ d I� /' 1 L Phone: SO .. - - -TJo 15
1<b) 1 Kd I it r /6 i V�V V^l Fax:7 ll..//u�i
❑ Applicant: l/�,I
1V
<C.- C1
I��j� "'� Phone:
I l�
( Fax:
Mailing Address:,Mailing
q.. u -t-1', Pia v k Pc ,
Address:
-
Ci State, Zip
/�*y �j
C)i�l(�rQC?
�� 1 I
City, State, Zip
❑ Contiactor Phone
Fax
gu
❑ Architect/Engineer
Phone
Fax
Mailing address
Mailing address
City, State Zip
City, State Zip
\VA State Contractor license #
Contact name:
PROJECT INFORMATION
Building height to peak
# of stories
Main floor sq. ft.
Unfinished basement sq. ft.
Dimensions
Total habitable space
2"d floor sq. ft.
Finished basement sq. ft.
Occupancy group
Construction type
Garage sq. ft.
Deck sq. ft.
Cost of project
Heat source (electric, gas, etc.)
Manufactured Horne
Sign
Width:
Length:
What is the square footage of the sign
ice?
How high is the sign?
Year:
Make:
# of signs
Area of existing signs
Previous address
Fire Sprinkler
Paint booth Fire Alarm
Tent
Fireworks display
Proposed use
Value
Special: Ins 7eC.'
Firm Name
Phone
cin Residentia
Plans Examiner
rode
Phone
Inspectors:
Address
Inspector
Phone
D Concrete O Welding CI Bolting O Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? el Yes D No
Ifyes, idents on site plan
What is the current property size?
(square feet or acres)
Is any part of the property within 250 feet of a shoreline?
Ifyes, identt on site plan 0 Yes VI No
What is the current use of this property?. ?
5-11.16; (41 al I' o n
Is your property in a designated wildlife habitat area?
O Don't know O Yes 0 No
Will the site be served by a septic system? 0 Yes O No
Is any part of the property within a 100 yr flood plain?
Ifyes, identi on site plan
O Maybe t5if Don't know O Yes 0 No
Are or will there be wells located on the property?
Ifyes, identity on the site plan O Yes J No
Are there any wetlands, streams or ponds within 200 feet of the property?
If yes, identify on site plan 0 Yes jgI No
Is there evidence of fill or excavation on the property?
0 Yes ® No
Are there slopes greater than 30% on the property? (30 ft rise m 100 ft)
(,G%) 0 Yes 124 No
Are critical or hazardous materials used or stored on site?
0 Yes 01 No
DEPARTMENT USE ONLY
Date Received:
Staff Representative:
METHOD OF PAYMENT
VISA
0 CASH 'I CHECK ❑ 11111111111111111 0
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE:
EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
SUBTOTAL