2004, 09-09 Permit App: BLD-04-07665 Residence • •
BUILDING PERMIT APPLICATION WORKSHEET
*Ione City of Spokane Valley Community Development Department
Building Division
�, _ 11707 E. Sprague Avenue, Suite 106
. .400,Val l ii 7 c E ll D : • • Spokane Valley, WA 99206
rr .Phone: (509) 688-0036;Fax: (509) 688-0037
• SEP 0 9..2004
REQ IR E INFORMATION'• ••
zi in
Street Address: 4/// 'i1? . &&t /y : • c Cz` '
.
Assessor's Tax Parcel•Number(s): . • .
• -
Legal Description: 7v-A..4 •. 17 4.-P U eAt.,_ 4'- `2. q < C
PERMIT DESCRIPTION: . • •
NE Building Permit ❑ Change in Use • D Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
• OWNER/APPLICANT INFORMATION _
•
❑ Owner: El Applicant:
Phone: • Fax: • Phone: . . Fax:
Address: . Address:
City • State Zip Code City .State Zip Code
❑ Contractor: C:Lx-d •❑ Architect: •
Phone: szz- 36 5 7 Fax:77z-- 78`09 Phone: Fax: - .
Address: G zzz- s, ci..-ter _ 4_.,,,m Address*:
•
__ ��`cam 3� 7929 4 •
o1y State Zip Code • City• State Zip Code
WA State Contractor License#:(311-5-7111C-11 71 C✓ Contact: /?,,,, j -
PERMIT/BUILDING. INFORMATION •
.• .
HEIGHT TO PEAK • • DIMENSIONS: #OF STORIES:-
ZzWA-37 /
MAIN FLOOR TO SQ. FTG: i 2mi FLOOR SO:FTG: -UNFIN BASEMENT SQ. FTG:
/ 274 7 /7
FINISHED BASEMENT SQ. FTG: GARAGE SO: FTG: �• • DECKICOV.• .PTIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTION TYP -G- • HEAT SOURCE:
•
/4S
! #OF BEDROOMS: Z TOTAL 1 j#A ZAI LE SPACE: IMPERVIOUS SURFACE AREA:
le)COST OF PROJECT: ' 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
fe. or,0 //to a SYSTEMA? ,S-ure-cam
• MANUFACTURED HOME •
Width.; • Length: Year:• Pit Set: • • •
Manufacturer: • . .
•
•
• •• •'. . .•
RELOCATION • • •
Previous Address: .
•
Proposed Use: • . •
FIRE SAFETY •
___
Fire Sprinkler: # of Heads: •• Fire Alarm: Paint.Booth;.
Tent: • Fireworks Display: Blasting: •' . • Da.telTime:
Valuation: • Above/Underground Storage Tank Size: •
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE . I
Plans Examiner: Phone: ' Fax:
Address: .
•
City State Zip.
Inspector: • Phone: Fax:
Address:
State Zip
• City
•
I11
SPECIAL INSPECTIONS I
.
0 BOLTING 0 CONCRETE • 0 REINFORCEMENT 0 WELDING
Firm Name: . . Phone:. Fax:
•
I nspector(s): '
•
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) Ail 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 offSpbkane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes rdinances.
Ownership of resulting development rights granted by any issued permit inur to the pro a when
Print Name . a /----- -1.541:14/1 ,
v� Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard).
❑ Cash 0 Check . 0 Mastercard . • 0 VISA 0 Other
Bankcard#: • •. Expires:. • • •VIN#; •
Authorized Signature: • • .
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. C. i 7 -3 ' This die plan is being submitted for the purpose of
obtaining a building porn*and is a true and torrent
representation of the . . . Ail known property
lines/. structures and easements
If hays basis irrdiaNd an weMands,
bodies of E �, areas.
other critical
5 Dear y.--2�-e'y