2004, 09-09 Permit App: BLD-04-07667 Residence •
• • 0 BUILDING PERMIT APPLICATION.WORKSHEET
*la a 144111201116 a p Spokane Valley Community
V E ty Development Department
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40? II eytp •09200h ' .-- • Budding Division
11707 E. Sprague Avenue, Suite 106
• • Spokane Valley, WA 99206
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a . .Phone: (509) 688-0036;Fax: (509). 588-0037
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• 211 I i__ [ N. . • -
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ow ' REQUIRED . .. .. .
REQUIRED SITE INFORMATION.-• 1 . . .
..4 . . . 1 .. (',.(/.5? •
Street Addrths: _QA t •
5 1 0 • 011.,. s:. --t- .t . iii,A
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...
Assessor's Tax Parcel•Number(s): • - •
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• - • r --T 4:.
Legal Description: T.--. 1.•• '7 b-P Cie-- - • 'or _',/ )I. 5 P-i1 ," 1,i_i
PERMIT DESCRIPTION: . • •
• • - . - -
El Building Permit El Change in Use • D Grading El Manufactured Home
p Relocation El Tenant Improvement. EJ Fire Safety EI Other
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OWNER/APPLICANT INFORMATION . s
0 Owner: 0 Applicant:
Phone: • Fax: • • • Phone: . Fax:
Address: . - Address:
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•• •
.. • City • State Zip Code City ,State Zip Code
El Contractor: •,4----.,5441...0 6)-..sJ ---c-;,.._ •0 Architect: •
Phone: ?2Z 36 i 7 Fax: yzz _7962r Phone: Fax:
Address: 4, izz_ s ehe_a_e.. .c.,.../, z.„.,e • Address:
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. 6,4,,, r77_0‘ . •
*e,-; • State Zip Code City • State Zip Code
WA State Contractor License#: 4/1-S-Tole_1/ 71 CK Contact: /ie.)), . .
• • • - PERMITIBUILDING.INFORMATIQN - •. • .
HEIGHT TO PEAK: • • DIMENSIONS: #OF STORIES:-
02/
5o5L • . ( .. •
MAIN FLOOR TO SQ. FTG: - 2mu FLOOR SQ:FIG: • --- ARVIN BASEMENT SQ. FTG:
?-5-0
) FINISHED BASEMENT SQ. FTG: . GARAGE SQ: FTG: • • DECK/COV. PATIO S.Q. FTG:
2.6,6) * . . • 5.zr . .
• . .
OCCUPANCY GROUP: CONSTRUCTION TYPE: . HEAT SOURCE:
q4-5
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#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
.Z.-- • 22 4 o
COST OF PROJECT: ' •acre) 30%SLOPES ON PROPERTY: *SEWER OR ON-SITE SEPTIC•
• - •
0. 410 - SYSTEM? <5 ./1-•-,---ri'
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MANUFACTURED HOME .
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Width; • •Length: Year:* Pit Set: • • •
Manufacturer: - . .
RELOCATION
. : Previous Address: . . •
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Proposed Use: . . . .
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FIRE SAFETY • _____1..
• Fire Sprinkler: # of Heads: Fire Alarm: Paint.Booth:
Tent: Fireworks Display: Blasting: - . . Datemme:
Valuation: . Above/Underground Storage Tank Size: .
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WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE • I
Plans. Examiner: Phone: • . Fax:
Address: . . . • . ..
• City State • Zip'
Inspector: Phone: Fax:
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Address: '
• City State . . Zip
SPECIAL INSPECTIONS 1
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0 BOLTING •
❑ CONCRETE • 0 REINFORCEMENT 0 -WELDING
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Firm Name: . . Phone:. Fax:
Inspector(s): 0 -
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DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 'f) 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 atthe 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 ordin ces. "
Ownership of resulting development rights granted by any issued ' rmit inure property owner.
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Print Name .tijc {yrs Signature •
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. Method of Payment: (Faxed permit applications will only be accepted with major bankcard). .
❑ Cash ❑ Check t [] Mastercard . • 0 VISA • 0 Other
• Bankcard#: • 0 Expires:- • • •ViN#• .
Authorized Signature: .
ti' J��\ MooAESS 1 ) 1 21
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V4-°''''l }yN\)- 110A1.)
WIDTH
1 `Cc, FRONT. _FLANKING
OMMENTS
REVIEWED SY t k
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This site plan is being submitted for the • . • of
obtaining a building permit and is a hue and -•
I r t.ptetsentation of the • • • • . NI known • •
luresrdimensio urb lines, • - - and
have been i. . Also • - • are
bodies of 7. , other allied .
3 t I "4` f Date: e r
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