2005, 05-24 Permit App: 05001755 Demolition of HouseStreet Address:
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
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: 6M
a
❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
❑ Owner.
Phone:
OWNERIAPPLICANT INFORMATION
ax:
city / state- Zip Code
❑ Contractor: kais
Phone: ' qQq �Qqb Fax: o
Address:
❑ Applicant: -ZO 6
Phone:- ax:
Address: Y6 , 35-1
❑ Architect:
Phone: Fax:
Address:
Code
city State Zip Code City State Zip Code
WA State Contractor License #:_1[ �i i� L % N366contact:
Spokane Valley Bus. Liscense #: Contact:
PERMITIBUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2 FLOOR SQ. FTG:
UNF1N 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?
Width: Length:
Manufacturer:
Previous Address:
Proposed Use: _
Fire Sprinkler:
Tent:
Valuation:
MANUFACTURED HOME
Year:
RELOCATION
FIRE SAFETY
# of Heads: Fire Alarm:
Fireworks Display: Blasting:
Above/Underground Storage Tank Size:
Pit Set:
Paint Booth:
Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Inspector:
Address:
Phone:
Fax:
city State
Phone: Fax:
city
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
Firm Name:
Inspector(s):
❑ REINFORCEMENT
Phone:
State
Fax:
Zip
Zip
❑ 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.
Ownershipof r suiting development rights granted by any issued permit ' re to the property owner.
Print Name /v Signature
Method of Payment. (Faxed permit applications will only be accepted with major bankcard)
❑ Cash X Check
Bankcard #:
Authorized Signature:
❑ Mastercard ❑ VISA ❑ Other
Expires: VIN#: