2004, 08-31 Permit App: BLD-04-07526 Deck • : BUILDING PERMIT APPLICATION WORKSHEET
Spobne i 'o€ City of Spokane Valley Community Development Department
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Building Division11707 E. Sprague Avenue, Suite 106
ev . . Spokane Valley, WA 99206
• Phone: 503 688-0036•Fax: (509) 688-0037
REQUIRED SITE INFORMATION`-. ..
Street Address; -7J7 (C� t, • .7 Ake _ ,,,, _ (Zig c' c2( Z
Assessor's Tax Parcel Number(s): . - .
Legal Description:
PERMIT DESCRIPTION: 00 Vere aeck_, - • -
❑ Building Permit ❑ Change in Use ❑ Grading 0 Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety . ❑ Other
OWNER/APPLICANT INFORMATION -
❑ Owner: 1.ereiv•.y ��ac k&:) , El Applicant:
• Phone: sc I -co h i Fax: Phone: Fax:
Address: .--j3 t' E '1 iku.---t - Address:
a )
.. • *PH State Zip Code City ,State Zip Code
El Contractor: ; 1,v- e.____ •❑ Architect:
Phone: . ' . Fax: Phone: Fax:
Address: , ' Address
City State Zip Code City - State Zip Code
WA State Contractor License#: Contact:
•
. • • • PERMIT/BUILDING INFORMATION • l
HEIGHT TO PEAK DIMENSIONS: #OF STORIES:.
MAIN FLOOR TO SQ. FTG: ?J FLOOR SQ.FIG: UNFIN BASEMENT SQ. FTG:
: FINISHED BASEMENT SQ. FTG: GARAGE SQ: FTG: • • DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTION TYPE: . HEAT SOURCE:
0 -
. #OF BEDROOMS: • TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF PROJECT: • • 3O%SLOPES ON PROPERTY: 'SEWER OR ON-SITE SEPTIC
• SYSTEM?
•
*MANUFACTURED HOME
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Width: Length: Year:• Pit Set: • •
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Manufacturer: •
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• •• . • RELOCATION •
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Previous Address: •
Proposed Use: .
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FIRE SAFETY •
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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
•
•
•
s SPECIAL INSPECTIONS•
•
1
Q BOLTING D CONCRETE 0 REINFORCEMENT 0 WELDING
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Firm Name: . . Phone:. Fax:
Inspector(s): •
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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) AU 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.
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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 ❑ Check 0 Mastercard . ❑ VISA • ❑ Other
• Bankcard#: Expires: •� •VIN#•
•
Authorized Signature: .
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COMMENTS
/0I REVIEWED BY w A is 14 ..--,"
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�p Tt site Aan is being sudrru}� for the purpose
obi airing Pia:Mills
permit and IsP Pose of
/x I rep resehtation of the a true and correct
line s/dimensions,curb riPmes sal' All known property
hev a been id@atiFied.lglsp struo}ynn and easements
l 7�/ bodies of-:waterrsteep are wetlands.
slopes t��re c►,i1ic I
/ 44, Signad•y .s ..•r-.1-..:4.' 1 Y / 8 areas.
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