2004, 03-24 Permit App: BLD-04-03886 Garage BUILDING PERMIT APPLICATION WORKSHEET
CIT\ City of Spokane Valley Community Development Department
Jane Building Division
11707 E. Sprague Avenue, Suite 106
4000V
ale Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: / /` j U 7 C -7--L)
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation n Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Applicant:
❑ Owner: ��e.-r2,i _,. � o t��sc ), a. ,\ [I] pP
Phone: I-6,,'6:,z Fax: Phone: Fax:
Address: //,-(5•) 5 c 7-._. Address:
-1'3
City State Zip Code City State Zip Code
❑ Contractor: /14.7
(c. , ,,, ❑ Architect:
Phone: YC,?-o c t. Fax(1 La,')—/1. s'? Phone: Fax:
Address: 63 5 z p FA..t�,� Address:
Sp./1 c,.., w,A s 9
City State Zip Code City State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STO R IES:
v x-3.)x-3.)
MAIN FLOOR TO SQ. FTG: 2ND FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP: CONSJU9TION TYPE: HEAT SOURCE:
o I.
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OFROJECT: 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
t(c.E 0 U SYSTEM? f
\4' r\\0(\
7\:)
C'�
MANUFACTURED HOME
Width: Length: Year: Pit Set:
Manufacturer:
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:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner: Phone: Fax:
Address:
City State Zip
Inspector: Phone: Fax:
Address:
City State Zip
SPECIAL INSPECTIONS
❑ BOLTING n CONCRETE ❑ REINFORCEMENT n 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 development rights granted by any issued permit,. re to the property owner.
Print Name 2v)) `De►,--F) Signature t
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA
❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
site is being for the purer of PERMIT SITE PLAN
obis planpermit and is a true and correct
obtaining a building pe proposal. All known p�1I TY OF SPOKANE BUILDING SERVICES
representation o the i f>�' res and easements
havedimensiden curb lines.structures am weds,
have been identified. Also o< otter criticalareas. P R O J N O:
bodies ter'Sytre�p I ALLEY O R A/L
� 4d y
Dom. "; 7i4°i "? \
ADDRESS/1-492--L— '14—,.-W REAR
ZONE
ROAD WIDTH C.J2
KI.
FRONT '( _..___.-
COMMENTS01
REVIEWED B IrA VAIRO4 {
A/L ) A L
LEGAL DESCR: 3°
I OR
OR
��• 3.a ^.
STREET HOU S_ STREET
• OWNER:
RESIDENTIAL FRONT
COMMERCIAL \,, ig—
JOB ADDRESS: 1 P/ 6 ? 5 9 7_-.