2005, 03-15 Permit App: 05000769 Fire Damage RepairStreet Address: / o
(Cly CI
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
REQUIRED SITE INFORMATION
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Assessor's Tax Parcel Number(s):
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Legal Description:
PERMIT DESCRIP
❑x Building Permit
❑ Relocation
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❑ Tenant Improvement ❑ Fire Safety
OWNER(APPLICANT INFORMATION
❑ Owner:
Phone: Fax
Address.
City State Zip Code
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❑ Other
❑ Applicant: (�oknQAc-\Dr
Phone: Fax
Address:
® Contractor: 3LeJ-Poo usA Gao.P T-Nc ❑
Phone:`a93-o6ol Fax:893-0ooro
Address: i ooao t lCNox s , Te i vo
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City State Zip Code
city
Architect:
Phone:
Address:
Fax
City State Zip Code
WA State Contractor License #: (j L- . i- o u & ggo6J" Contact:
PERMIT/BUILDING INFORMATION 777771
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES.
MAIN FLOOR TO SQ. FTG:
2 Nu FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SO. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
# OF BEDROOMS:
CONSTRUCTION TYPE:
TOTAL HABITABLE SPACE:
HEAT SOURCE:
IMPERVIOUS SURFACE AREA:
COST OF�P OJECT.
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
Width: Length:
Manufacturer:
Previous Address:
Proposed Use: _
MANUFACTURED HOME
Year: Pit Set:
RELOCATION
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm:
Tent: Fireworks Display: Blasting:
Valuation: Above/Underground Storage Tank Size:
Paint Booth:
Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
Fax:
City - State Zip
Inspector: Phone: Fax:
Address:
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
Firm Name:
Inspector(s):
❑ REINFORCEMENT ❑ WELDING
Phone:
Fax:
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 inure to the property owner.
Print Name
Signature
Method o/ Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA
Bankcard #:
Authorized Signature:
Expires:
VIN#:
❑ Other