2004, 09-08 Permit App: BLD-04-07595 Finish Basement TSan BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
• Building Division
11707 E. Sprague Avenue, Suite 106
. .4010011ValleY.
• • Spokane Valley, WA 99206
Phone: (509) 688-0036•Fax:
(509) 688-0037
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REQUIRED SITE INFORMATION. -•
StreetAddress: j/4 _ g 1 I E7kE.ir? AA KE- LAE
Assessor's Tax Parcel Number(s): . • .
•
Legal Description: :.
PERMIT DESCRIPTION: . . - .
wilding PermitGhan a
0 Relocation ❑ g in Use ❑ Grading ❑ Manufactured Home
D Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
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7 Owner: is HAS j/1'1 A ❑ Applicant: gel 4
Phone: q81-c 77B Fax: . \ • Fax:
Address: .3/i o. S CO . KK � Address:
Q A7K A tE MLLE - A 99Q37
City • State / Zip Code City State Zip Code
0 Contracto . _. •
.. ���' g�oK��❑ Architect: � A
- '- _ - -: ;A ... - .b�AII 7W- - Phone: Fax: .
Address: -6Y:o • .1 Address:
Li : TV LAKE / 1Q/9 •
•
ok.
State Zip Car* City • State Zip Code
WA State Contractor License#: Ali , -_ ontact: .--ge-e-- -AFF--/--EAS
PERMIT/BUILDING INFORMATION 1
• HEIGHT TO PEAK: • DIMENSIONS: #OF STORIES:.
MAIN FLOOR TO SQ. FTC: -2Nu FLOOR SQ.FTG: UNFIN BASEMENT SQ. FTG:
• FINISHED BASEMENT 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: D2 30%SLOPES ON PROPERTY: 'SEWER OR ON-SITE SEPTIC
�l v32 I ...". • SYSTEM?
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MANUFACTURED HOME .
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Width; • Length: Year:• Pit Set: . • •
Manufacturer: •
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• RELOCATION • ••
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Previous Address: •
Proposed Use: •
FIRE SAFETY •
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Fire Sprinkler: # of Heads: Fire Alarm: Paint.Booth:
Tent: • Fireworks Display: Blasting: • . . Date/Time:
Valuation: . Above/Underground Storage Tank Size:
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WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE .
Plans Examiner: Phone: Fax:
Address: ••
• City State Zip.
Inspector: • Phone: Fax:
Address: •
City State . Zip
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SPECIAL INSPECTIONS
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CI BOLTING 0 CONCRETE • ❑ REINFORCEMENT ❑ -WELDING
Firm Name: . . Phone:. Fax:
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Inspector(s):
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DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that 4) 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'Spbkane 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.
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Print Name • Signature
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Method of Payment: (Faxed permit applications will only be accepted with major bankcard)•
❑ Cash ❑ Check . 0 Mastercard . ❑ VISA _ • 0 Other
• Bankcard#: Expires: • •VIN#:
Authorized Signature: