2005, 02-10 Permit App: 05000425 Garage BUILDING PERMIT APPLICATION WORKSHEET
S`m .ne#4\l‘kCity of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
4001
�11� Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: -D- ►---) . \-•--)A\Y.` -r- \ ( k,ap•2
Assessor's Tax Parcel Number(s): <\1 \ - 3 ‘ (DI
Legal Description:
PERMIT DESCRIPTION:
Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
1 OWNER/APPLICANT INFORMATION
❑ Owner: C\4, -Cell ❑ Applicant: /CS
Phone: Fax: Phone: Fax:
Address: 8-,,, . hp - \-34''''--V- Address:
Cit ;00S c State:\,k, Zip: cnLL L City: State: Zip:
Contractor: (c±I'S '71 -.--5-��-- gu6(Ci`ptiN1 ❑ Architect:
Phone: Fax: K-0‘\r1 Phone: Fax:
Address: 2-'1.0-S S- ( ' Address:
City32t\ cz State: l,a Zip: `fid 3) City: State: Zip:
WA State Contractor License#: Contact:
I PERMIT/BUILDING INFORMATION I
HEIGHT TO PEAKDIMENSI : #OF STORIES:
MAIN FL . _- 27 FLOO --- UNFIN BASEMENT SQ. FTG:
FINISHED FSS:- --- DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTIONTYPE: HEAT SOURCE:
0
#OF BEDRO •T HA ITABLE SPA�F: E) ) IMPERVIOUS SURFACE AREA:
COST OF PROJECT: l/o OPE ON PR(7PERT9 SEWER OR ON-SITE SEPTIC
,k tQ�� o SYSTEM?
r
MANUFACTURED HOME
Width: Len• •• Year: Pit Set:
Manufacturer:
RELOCATION
Previous Address:
Proposed Use:
L. -_ 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 0 REINFORCEMENT 0 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 develo•m-' '•• • •- • if •s • • an issued permit inure to the pro.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash 0 Check 0 Mastercard 0 VISA 0 Other
Bankcard#: ires: VIN#:
Authorized Signature:
ift, (-)
11 ', S'f,je, (;\ •
' ') <
rf
122ar\\ p O5 P '"
P p a[�
ZOROA)\,... ‘) A iv. " . .
11 NEIll" l /
EFRONi"
COMM
eilliMilr
6? ' - .„ , DU
V) ,r,.,
'T >deP.
,,c , ci 4„) f_. F
... \‘‘ 1 .
)
,p
This site plan is being submitted for the pwpoN of
obtaining a building permit and is a true and correct
Jrei :, sen'ation of the proposal. All known properly
lines dimensions.curb lines,structures and easements
have been identified. Also indicated wetlands.
Oodles of water. steep s •- - •..' acritical areas.
Shined:
8)F-6. 86'
-------------
____-------- Wis,AIN -r- V_A --------->
l
� 3d `e
ujc?. r .e._ Z___ ...-,.._-"
(L9