2004, 04-20 Permit App: BLD-04-04125 Pole Bldg BUILDING PERMIT APPLICATION WORKSHEET
SCT' (W City of Spokane Valley Community Development Department
imamBuilding Division
11707 E. Sprague Avenue Suite 106
4,0,00Vaney
Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address:
/ 5' O7 r ilr�
nn
Assessor's Tax Parcel Number(s): S O Ct 3 . 0 10 3 l)‘Q 3
Legal Description:
PERMIT DESCRIPTION:
f�Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
El Owner: lir' / 1 WI )Co fes. ❑ Applicant:
Phone: 7,23s(0 Fax: Phone: Fax:
Address: t Seo 7 F' 1L ' Address:
Vfgfipii.E_ uok 7903 7
City State Zip Code City State Zip Code
❑ Contractor: AIL, ra.,.�.. El /Architect: p 8 ;To s 0 r.--
Phone: L167-01,G, Fax: 'G' -r. r ? Phone: L(� ro, Fax:
Address: 9,-2c N Fac Address:
�J Cru..w� wv4 7
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City State Zip Code City - State Zip Code
WA State Contractor License#: At I4 Fa.rc,.c i(1Y),lia Contact: lap) It4 cZor.,Jel..
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
20 qo KNu 1
MAIN FLOOR TO SQ. FTG: 2"" FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRjIQN TYPE: HEAT SOURCE:
ro Le
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF PROJECT: 30% SLOPES ONOPERTY: SEWER OR ON-SITE SEPTIC
Fit's SYSTEM?
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 ❑ 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 laws, codes or ordinances.
Ownership of resulting development rights granted by any issued pertiit ure to the property owner.
Print Name 90,4 Aii-`'apv Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check 0 Mastercard ❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature:
My Family Contractor, Inc.
8525 N. Freya. Spokane,WA 99217 ,co g 6
(509) 467-0106 • FAX (509) 467-1257
License#MYFAMCI022R0 -
SALES CONTRACT AND WORK ORDER �y
OWNERS NAME Bi !t R tA./ I O ' PHONE 922 3 S'4, 0
HOME ADDRESS IS 41E14 pili CITY Vt► w d 414. COUNTY SAS--N W STATE W A ZIP q90 3 '
JOB ADDRESS (if different from home address),
By affixing signature below owner(s) of the premises mentioned hereby authorize you as contractor,to furnish all necessary materials,
Tabor, and workmanship, to iilstahl, construct and place the_iniprovements according to the following specfications,'terms and
conditions, for the folhow ng project. - .µ $,� _
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INTENDED PURPOSE OF PROJECT "''`
BUILDING SIZE_WIDTH '°( (-, L GTH 0 HEIGHT
vi
EAVE "U s t{� /.:� 4 °ROOF PITCH /..d2-- TRUSSES PRE-ENGINE ED FACTORY-
FRAMING POST 6"-' 'Cr?C`3 STUD _: ' i" INSULATION SIZE P#:; � r" LOCATION"
COLORS BODY J L�. ROOF 1441....A.,-. TRIM % TRIM STYLE o_ I) - "
SLIDING DOOR(S)SIZE a•--- I`j _ •4 OVERHEAD DOOR(S)SIZE I' i (' 73. '?
WALKIN DOOR(S) 1 -''ti G t`' WINDOW(S) SIZE i /me.'
WALL LIGHTS SKYLITE
CONCRETE FLOOR SIZE 140'144x" tf 1. APRON OR DRIVEWAY "' " "1 - d I CP ',we's:Mirk
ROUGH FINISH❑ SMOOTH FINISH CJ r'..4, „,,. -1 :1..-C ,..Mr'ID
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IF GABLE END--).-I L.__ 7.7-tIc...
NOTICE TO CUSTOMERS Cash Price $ ti c, i41.2 _
Prior to the start of this project a signed contract Delivery Charge $ _
shall be completed. 10% to 50% of this estimated Tax $ 2. 62. 2. L 1. 01 -
project shall be payed by the owner to the contractor Permit $ g-K i€o A !Arc.
prior to. Total
the commencement of starting. $ 2‘
9 q i,q4
On completion of work owner shall paythe "�t #
p Down Payment $ � �" �t ' Check# ,f..� _'� Date �-',7--fCi - :- AN
contractor those dollars invoiced and still owing. '
Balance $ i- l- 1 ,•,
The value of the labor and materials are as 4y iti. ' .l. ''
1st Payment $ I I '`? '. ' " ate ra.
estimated by the contractor and subject to labor �f r-)' ` ..° ...
and material liens. 2nd Payment $ 1 I °'., - r R�Date Pd.
�? ,� , �+ r . . • 1,.+'a'-� t —
3rd Payment $ ,f r^ 1- + �" _ ate Pd.
Eighteen (18) percent interest is charged on all
overdue accounts. Reasonable attorney fees will Site Prep $ i
.o an hour-not in contract unless filled in. a
be assessed if a suit is commenced to collection. Floor Prep $
Cancellations are subject to a eighteen(18)percent $75 an hour-not in contract unless filled in.
e to be made against contract. Dump Truck Fees $
charge g $180 a load-not in contract unless filled in.PLUS DUMP CHARGES
I
Owners Responsibility: Owner agrees to assume responsibility for the constructed installation covered under,
the contract being within: his property lines and not in violation of setbacks or other restrictions, to provide
adequate and substantial roadway ingress and working area, to pay on the basis of actual labor, materials,
equipment rental for the delays and corrective measures necessitated by unknown underground pipelines, and
conduits, removal of masonry, removal, refilling, compaction of ground inadequate bearing capacity, excavation
in rock, hard pan or other materials, the diversion of sealing off of water seepage, and for changes of additions
to the installation structure or other construction nei'essitated by such conditions.
Regarding the items mentioned above, it is agreed that he/she has no superior knowledge and that payment
for such additional work will be due and payable on completion of such work unless otherwise arranged.
Site preparation including the removal of protection of vegetation, pipelines or other improvements shall
be done by the owner unless otherwise stated herein. Due to the weight of contractors equipment, contractor
is not responsible for damage to existing curbs, sidewalks, driveways, slabs, lawns, and flower beds, etc. as a
result of construction.
Fill as required is to be provided and paid for by owners and is not part of the contract and agreement unless
otherwise stated. Backhoe, generator, jackhammer, dynamite is additional,,if needed, and will be assessed to
homeowner. Labor for jackhammering is extra. , ? t � `T ,
,,„
,e, 6 a
All surplus material is property of contractor. `hi1 g L ;-.9 _.
*
No completion date will be specified without written approval fforn the office. All jobs will be completed
as soon as possible, but the company is not responsible for delays caused by bad weather, strikes, reasonable
material shortages from supplies, or acts of God. In;the event of the break of this contract the property owner(s)
also agree to pay reasonable attorney's fees for consultation and/or litigation, including all expenses as may
be necessary.
My Family Contractor, Inc. warrants that said work will be free from defects in materials and labor for a
period of one year from the date of acceptance of completion by owner unless such materials or items are
covered by manufacturers warranty.
"This agreement shall constitute the whole agreement of the parties and may be changed
only by written change order as agreed to by all of the parties."
4,4} --.
XDate X �rj�. dict, 4"x/14/ Dat
REPRESENTATIVE OF MY FAMILY CONTRACTOR - - OWNER/BUYER.
Dia
r t rZe.X eate X / � Date
ACCEPTED BY PRESIDENT OF MY FAMILY CONTRACTOR OWNER/BUYER
CAUTION: Concrete floors may crack in the Pacific Northwest for any number
of reasons.Therefore, we will not be responsible for cracks in concrete floors.
However, we do use material from reputable companies. Also, imperfections
in sface level is unavoidable and therefore not guaranteed.
Wood products may form pitch pockets as they cure.This is unavoidable and
therefore:My Family Contractor will not be responsible for any change caused
by the pitch dropping.
. .
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ROAD vinDTAL-
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REVIEWED BY 111:4ffimmaipm !
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representation ot the propeesileinowes. MI lenbarnand .. 1111,- — . _
lines/dimensions.c.urb lines. _ ameseellare.
have been kientibect. Aleb thilliel•a cou=s811. 154°5 C i111
bodies of Water.
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Signed: / "" ' -
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