2004, 08-30 Permit App: BLD-04-07507 Egress Window .. . '%- 101 - 75-0
BUILDING PERMIT APPLICATION WORKSHEET
Slitikane
City of.Spokane Valley Community Development Department
Building*Division
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11707. E. Sprague Avenue, Suite 106
.400001;Valle • • • . Spokane Valley, WA 99206
• .Phone. (509) 688-0036•Fax: 509 688-0037
REQUIRED SITE INFORMATION •
Street Address: / 3`7Z/ 7 • • /-s-/ . /
Assessor's Tax Parcel Number(s): . • .
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Legal Description: -. .
PERMIT DESCRIPTION: rims
e . L-(U/ N10 tu - • - -
L Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
O Relocation El Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: 1/i L L. /9 // (LT 14 Applicant: /%a ,z,/,,beT
Phone: qz 6/51.04, Fax: . Phone: Fax:
Address: / z/ 7 E /.5--741 - Address:
• S/Pbe-A-nib 1/a/�47y GL4. 9.92/6 - .
City •
State Zip Code City .State Zip Code
❑ Contractor: • :11° 1‘-' s .❑ Architect:
Phone: Fax: Phone: Fax: -
Address: , • • Address
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City State Zip Code • City• • State Zip Code
WA State Contractor License#: Contact:
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PERMIT/BUILDING INFORMATION .
HEIGHT TO PEAK - - DIMENSIONS: #OF STORIES:..
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:
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OCCUPANCY GROUP: CONSTRUCTION TYPE: • HEAT SOURCE:
. #OF BEDROOMS: - TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF PROJECT: - • 30%SLOPES ON PROPERTY: -SEWER OR ON-SITE SEPTIC
- Or a • SYSTEM?
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MANUFACTURED HOME
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Width; Length: Year:' Pit Set: ••
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Manufacturer:
RELOCATION •
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Previous Address: •
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Proposed Use: • • . •
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:
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WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE .
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Plans Examiner: Phone: Fax:
Address: ••
City State Zip
Inspector: Phone: Fax:
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Address: ••
City State . Zip
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SPECIAL INSPECTIONS•
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❑ BOLTING ❑ CONCRETE • 0 REINFORCEMENT 0 -WELDING
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Firm Name: . . Phone:. Fax:
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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) 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.
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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 0 Check 0 Mastercard . • ❑ VISA • ❑ Other
• Bankcard#: Expires:' • VIN#:
Authorized Signature: