2005, 07-22 Permit App: 05002879 Addition, Reroof Garage BUILDING PERMIT APPLICATION WORKSHEET
Sin
or Development Department
11,ttsrfr7P7ommunity Building Division
11707 E. Sprague Avenue, Suite 106
41,V
a ev ��L L2 2 � Spokane Valley, WA 99206
❑ Ph • (509) 688-0036; Fax: (509) 688-0037
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REQUIRED SITE INFORMATION t 3 - 2. .1-1q
Street Address: 3 8 U 3 So, VI UOULr a' Y;----i- it,---
Assessor's Tax Parcel Number(s): 4/5- 3 3 a.. 3 3 v� lq . oco
Legal Description: L 0 + a, E to c.,k-a, At k/ S ems.. 3 3 ) r- a 5, g ye7
PERMIT DESCRIPTION: . Lo n on Garc,y-Q
Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation n Tenant Improvement n Fire Safety I I Other
OWNER/APPLICANT INFORMATION
Zi Owner: Z h' a w. ( i ^ ❑ Applicant: Z .
Phone: g 9 9- / 9 02 3Phone: Fax:
Address: 3i'0 ':." So , Gvl v o c coria rQ Address:
City: o ,i State: W A Zip: 9 9 2.06 City: State: Zip:
❑ Contractor:/ ❑ Architect:
Phone: Fax: Phone: Fax:
Address: Address:
City: State: Zip: City: State: Zip:
WA State Contractor License#: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: ( DIMENSIONS: / #OF STORIES:
i0 9 x 5-p ' /
MAIN FLOOR TO SQ. FTG: 2"U FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG: GARAGE TG J J� ¢ DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:__
#OF BEDROOMS:' TOTAL HABITABLE/SPAC2. Er IMPERVIOUS SURFACE AREA:
COST OF PROJECT: 0 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
v - SYSTEM? -
M MANUFACTURED HOME
Width: — Length: --- Year: ---- Pit Set: --
Manufacturer:
RELOCATION
Previous Address: —
Proposed Use:
FIRE SAFETY
Fire Sprinkler: ---µ` # of HeadsFire 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 lays codes or ordinances.
Ownership of resulting development rights ranted by any issued permit' ure o the property owner.
O vv ( ' "\ Signature a.w-,_� ,_
Print Name i �`
Method of Payment: (Faxed permit applications will only be acc:pted with major bankcard)
\Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature:
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PROVIDE DIAGRAMS AND
ENGINEERING LAYOUTS FOR
ROOF TRUSSES, BEAMS AND
FLOOR SYSTEMS PRIOR TO FRAMING
INSPECTIONS
CITY COPY
THIS BUILDING SUBJECT
TO FIELD INSPECTION CORRECTIONS
REVIEWED FOR CODE CO PL CE
SPOKANE VAI LEY Rt,ll Dl DI SION�