2004, 07-12 Permit App: BLD-04-07051 Shop BUILDING PERMIT APPLICATION WORKSHEET
SCM'orrad\ftei& City of Spokane Valley Community Development Department
t1Building Division
E. Sprague Avenue
.0,00Valley
11707 , Suite 106
Spokane Valley, WA 99206
Phone: (509) 688=0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: i-5/0 5 % LA,-)e I /v'
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: Port 13Li„._..),„k„
I Building Permit El Change in Use El Grading ❑ Manufactured Home
n Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: 34e(3/b2,4 _. Z [vr Applicant: ,erc -i,), )
Phone: qts-43410 Fax: Phone: car:-c4-9W Fax:
Address: 25/0 5. ;i.p,ace.4, -- Address: 5A)446-
VOVADAt.z 1441- er1037
City State Zip Code City State Zip Code
❑ Contractor: ❑ Architect:
Phone: Fax: Phone: Fax:
Address: Address:
City State Zip Code City - State Zip Code
WA State Contractor License#: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: 14 DIMENSIO S:x �� #OF STORIES: ,
MAIN FLOOR TO SQ. FTG: 2'�`'FLOOR4SQ. FIG: UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
720 fa
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
Fora BLig&.a,#.Jq
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF PROJECT: S�I �; 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
SYSTEM?
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: Date/Time:
Valuation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner: Phone: Fax:
Address:
City State Zip
Inspector: Phone: Fax:
Address:
City State Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE ❑ REINFORCEMENT ❑ WELDING
Firm Name: Phone: Fax:
Inspector(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) 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.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA El Other
Bankcard #: Expires: VIN#:
Authorized Signature:
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Plans Receive
AREVIEWED :y !�.�a7:,�_�` .
,x APlans Checker
This site is being submit,*fa►Mw of v
planobtaining a �'%v Plans Return('
representation of the proposal. AN known /�Y 44/
lines/dimensions,curb lines,structures and euereents
have been identified. Also indicated are wetlands. Plans Picked
bodies of wate slopes or otter critical areas. 4 ' (/) )
` Plans Mailed ,
Date:Da -7-1i-O4 L
SOUT
reby certify information su ittee is correct and there are no other structures locat(
A ' , I° I / . 4 — I Cir- -7.
Owner or Agent Date
1 USE OR STRUCTURE PERMIT MUST BE ON THE PREMISES BEFORE CONSTRUC
NOT A PERMIT.