2004, 09-09 Permit App: BLD-04-07668 Residence ,� I -' c E �. • BUILDING PERMIT APPLICATIONS WORKSHEET'
of.Spokane Valley Community Development Department
. .4000, poar
S" 09 2flQ Building Division
la . .` 11707 E. Sprague Avenue, Suite 106
�IO � [�] • Spokane Valley, WA 99206
6.0 U .Phone: (509) 688=9036;Fax: 1509) 688-0037
y REQUIRED SITE INFORMATION'-• .
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Street Address: , -..1 ""i' • n • ( ,Q:.N1 - Ai- . • ,,cie, -37 7 ..
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Assessor's Tax Parcel'Number(s): . • .
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Legal Description: —77r -F •V 6-iejk, • /.,i fJ)34
4' th-
PERMIT DESCRIPTION: . . .
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►1 Building Permit ❑ Change in Use • D Grading ❑ Manufactured Home
0 Relocation
❑ Tenant Improvement ❑ Fire Safety . ❑ Other
• OWNER/APPLICANT INFORMATION
❑ Owner: ❑ Applicant:
' Phone: • Fax: • Phone: . Fax:
Address: Address:
City • State Zip Code City •State Zip Code
❑ Contractor: .igd,47-— ..a,-,.moi .z
Phone:5'22-36 `7 Fax: y zz_ 7 8&3 ❑ Architect: •
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Phone: Fax:
Address: 4:zz2 s C .L- e- ,..,.. Address:
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city • State Zip Code City • State Zip Code
WA State Contractor License.#: /--,04-57-ill C I?'1 I Contact: ,e0,,"d), -
• _ PERM1TUBUILDiNG•INF.ORMATIOht • • .
HEIGHT TO PEAK: •/ DIMENSIONS: #OF STORIES:, / ..
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MAIN FLOOR TO SQ. FTG: -` 2"''FLQOR SO:FTG: • -- 4l'tFIN BASEMENT SQ. FTG:
. `720 lIc-ci
FINISHED BASEMENT SQ. FTG: . GARAGE SQ FTG: •
,D • DECK/COV. PATIO SQ. FTG:
,)1 i ' a '
°CCUP.ANCY GROUP: CONSTRUCTION TYPE: HEAT 'O RCE:
. voce- F , - 9"
#OF BEDROOMS: . TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
LZZo
COST OF PROJECT: . 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
/tb 'SYSTEM? ...5,-(,----
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MANUFACTURED HOME •
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Width.; • Length: Year:' Pit Set: • ' •
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Manufacturer: •
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. • RELOCATION • •
. : Previous Address: . . .
Proposed Use: • - ' •
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FIRE SAFETY •
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• Fire Sprinkler: # of Heads: Fire Alarm: Paint.Booth:
Tent: Fireworks Display: Blasting: •'• . . Da.terTime:
Valuation: . Above/Underground Storage Tank Size:
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WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans. Examiner: Phone: - Fax:
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Address: . . • .
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City State •
Inspector: Phone: Fax:
Address: •
• City State . . Zip
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SPECIAL INSPECTIONS
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D BOLTING •
❑ CONCRETE • 0 REINFORCEMENT ❑ WELDING
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Firm Name: Phone:. Fax:
Inspector(s): •
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DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 'l) 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 Per ' - -F.... 5) This City of`Spbkane Valley
Permit is not a permit or approval for any violation of federal, state or local - s, codes or ordinances.
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Ownership of resulting development rights granted by any issued R-rmit i ure to the property owner.
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Print Name '�a E�+ n
Signature
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. Method of Payment: (Faxed permit.applications will only be accepted with major bankcard).
❑ Cash ❑ Check . 0 Mastercard . • 0 VISA . ' ❑ Other
• Bankcard#: Expires:. - •VIN#:
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Authorized Signature: •
' � � ..ZONE �9
, .; - �'\vl ROAD WIDTH i Y I"Jwti'cz ..nt kL� y FRONT Lig' RANKING
A COMMENTS
REVIEWED U°Y
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L live sees M! is being submitted for the purpose of
obtaining a> ding permit and is a true and correct
r propo :I All known property
I. curb lines sir ctures and easements
have been identified. Also i r dicatc i ate wetlands.
bodies , • st • ;,..•,• othei critical areas.
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Signed:
Date: 9— 2d e Y