2004, 09-14 Permit App: BLD-04-07648 Remodel, Addition •
• BUILDING PERMIT APPLICATION WORKSHEET-
CM'ale_1111_1!1•11\1611%,
City of Spokane Valley Community Development Department
3t1P01(an.ci Lje i Building Division
11707 E. Sprague Avenue, Suite 106
. .400010r V ev. • • Spokane Valley, WA 99206
.Fhone: (509) 688=0036;Fax: (509) 688-0037
•s
REQUIRED SITE INFORMATION.••• . . .
,� ' S . Z-S l T . .Tt 9l R p 2.c-SF-4 pa_
Street Address: .
Assessor's Tax Parcel•Number(s): 4.sasc? , spa 3
Legal Description: L-eT" •P , I2`-0c-41-- a •-0-P- Tirim s- -* s. +vim Pae--• Pte. Jt-4,4a 6 Q#46ago
PERMIT DESCRIPTION: Q 1)-771+CL"./1 /4,4i-0434A-a / SIL w- trjJ -
❑ Building Permit ❑ Change in Use • ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety . ❑ Other
OWNER/APPLICANT INFORMATION .
❑ Owner: b'gtn . • 0 Applicant: 6•a ev-s z r 41a6 WSJ
• Phone: •q2-2.-- 241,1-6 Fax: • -�-a-r-- to4r • Phone: 42z - a 1I L Fax: 4ss-15 3 4-r
Address: .s!. zs►r TtNgsrp-L4-4Q 4i.-0._- - Address: J . 2rir Tinaea•-u►.}a oo_
c-•a.K.*Jv J 42-Y O4- - 44-Po q-- Mk-a•JP Jatc..ia c �J - ggNSa 4
City • State Zip Code City State Zip Code
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❑ Contractor: CI Architect: X14'- a4-0)
Phone: Fax: .• Phone: 9 z ,6- -4-I. -2 Fax:
Address: Address: 12¢16 5- E a-aT- 2s-TA- •j
&Pew-fiJd • JtiCrg24{:›
City State Zip Code City• • ( State - Zip Code
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WA State Contractor License#: Contact:
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• • • .- PERMITIBUILDING.INFOR ATIO.N
HEIGHT TO PEAK • • DIMENSIONS: #OF STORIES:
MAIN FLOOR TO SO. FT : ` "" Q Q:FTG: - UNPIN BASEMENT SQ. F
FINISHED! BASEMENT Q. FTG: SQ: FTG: ilf .'• IQ . . ATI,f,Q. FTG:
OCCUPANCY GROUP: CONSTRUCTION �, H 4 URC
#OF BEDROOMS: TOTAL HABITABLE SPACE: lb
I PERVIOUS • -FACE AREA: .
COST OF PROJECT: • 30%SLOPES ON PROPERTY: 'SEWER OR ON-SITE SEPTIC•
-SYSTEM?
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•
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MANUFACTURED HOME . •
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Width.; • Lenigth: Year:' Pit Set: • • •
Manufacturer: . •
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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: .
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WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans. Examiner: Phone: • Fax:
Address: - .
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• City State • Zip'
Inspector: Phone: Fax:
Address: • •
•
City State . Zip
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SPECIAL INSPECTIONS
0 BOLTING •
❑ CONCRETE • 0 REINFORCEMENT ❑ -WELDING
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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 compilance 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.
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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 0 Check . 0 Mastercard . • 0 VISA • 0 Other
• Bankcard#: •, • • - • Expires:- • - •VIN#: .
Authorized Signature: •
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