2004, 04-28 Permit App: BLD-04-04213 RemodelSponkane
sonalley
•
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206.
Phone: (509) 688=0036; Fax: (509) 688-0037
1
REQUIRED SITE INFORMATION
Street Address'
Assessors Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
❑ Building Permit ❑ Change in Use ❑ Grading
0 Relocation ❑ Tenant Improvement ❑ Fire Safety
❑ Manufactured Home
9 Other
OWNER/APPLICANT INFORMATION
9 Owner: /r//1,6 S7umnn
Phone: 928-7/99 Fax:
Address: /yoi/ E. 8a ,4+rr
svoxnry ',ma -7 ton 99037
City State Zip Code
❑ Contractor: krrc'/ vJ rune 146
Phone: ysr- 72r0 Fax: a99 -318z..
Address: /09/f S• G >a uir✓ t„i
mntccc ismer /v,4 9902,2.
City State ZZp Code
❑ Applicant: 7-6/7 fort
Phone: 879-9'rsq Fax: g9/-6373—
Address: VYoy M muo,or
S/'ettivs Gv�P 9 92/ z.
City State Zip Coda
Architect:
Phone:
Address:
Fax:
City -
WA State Contractor License #: Contact j9c23 gr/>a
State
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
tu FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ: FTG: •
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE.
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT•
/62�
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Width; Length:
Manufacturer:
Year:
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent:
Valuation: Above/Underground Storage Tank Size:
Fireworks Display: Blasting:
Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner. Phone:
Address:
Inspector;
Address.
Fax:
City
Phone:
State
Zip
Fax:
City
State
Zip
SPECIAL INSPECTIONS
❑ BOLTING
0 CONCRETE
❑ 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) 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&pbkane 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 majorbankcard).
❑ Cash ❑ Check ❑ Mastercard . 0 VISA - ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature: