2004, 03-22 Permit App: BLD-04-03827 Remodel 3-- t7.oUt
BUILDING PERMIT APPLICATION WORKSHEET
CITY cF City of Spokane Valley Community Development Department
ne Building Division
11707 E. Sprague Avenue, Suite 106
4000Va
��E' Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: E. )0,2l3 /64-)
Assessor's Tax Parcel Number(s):
Legal Description: 1 I /
PERMIT DESCRIPTION: Con v erten cj Glup(Px 1 S/o &rn i,i iC 07)1+
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❑ Building Permit N Change in Use ❑ Grading ❑ Manufactured Home
E Relocation Tenant Improvement [, Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
M Owner: GerciU `" R€ a Si eCJel x❑ Applicant: W, 1)1 G . 5,e5ef
Phone: ?2. ) bq 65 Fax: Phone: 0/AP, -)//,./ Fax:
Address: E, I e 717 164?,4 dd ress: E 10-A13 1 -I') r Spb. V4/Ity
jkC11( ell / 14:/a e3ga06, Mai --pd (3bx 35)8 9Cr)�>6
Ci YState Zip Code y State Zip ode
P5�-C V !(ty, WA 11213 3..x16
n Contractor: ❑ Architect:
Phone: Fax: Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: : MENSIONS: #OF STORI7S:
/MAIN FLOOR TO SQ. -e 2"" FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
l ird1.3 - Gil + (1O2i ,7.o , -
'�-FINISHED BASEMEN SQ. F , : GARAGE SQ FTG: , (.. DECK/COV. PATIO SQ. FTG:
-__ '10;23 ,375-0-(1�2is�,9,'- 'lrL)
OCCUPANCY GROUP: C STRUCTION PE: HATS URCE
ete CM c_ l^4s c iC-ci
OF BEDRO S: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
!X213 a -i- bai5 a 3
OS-OF PROJECT 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
4 G�b cc SYSTEM? ,sej ie_t"
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 per it in to the prop rty o r.
Print Name l,(i , ))l ) G ry,�� Signature � _ l/ j ���
J 7-
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
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SEWER CONNECTION INSPECTION REPORT h
INSPECT. ATE : /0 - e-) I - q4 PERMIT No. : 3 - ' ' INSPECTOR L Y 'r`�` �"
PIPE TYPE & SIZE : 4 " PvC 03 o3 4 y.'4 :..47.;:;'-"
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ADDRESS : E. 1 0 .. ! r 16 .r " .t)6/6 CONTRACTOR : '/'r/''' 'ConAi
U//?"96F,�? 7 / /�L4C6- U,-6138
SUBDIVISION / U.L.I.D. PARCEL No. 452o¢, 3830 LOT : BLK : s
YES NO OTHER SEWAGE CONTAINER(S) ABANDONED ? YES iiii NO 0 TO BE ABANDONED IN THE FUTURE;
;OMPLETED APPROVED EXTERIOR CONNECTION ? 'l 0 0 BY: Eli CONTRACTOR or 0 OTHERS BY: 0 CONTRACTOR or ['OTHERS
NTERIOR PLUMBING CHANGES ? YES 0 NO MW UNKNOWN 0 ALL WASTEWATER SYSTEMS CONNECTED ? YES !: NO❑ UNKNOWN❑ . t'° ,
:OMMERICIAL BLDG : ■ NEW ■ RESIDENTIAL BLDG : III NEW • 'DOUBLE PLUMBING : 0 'OKAY TO BACKFILL ? YESEI NO❑'
ON UP—DATE : C —" `" j
PENDING : 0 ,
93--08 - 38?O 8.8 , START :_.
-�L BILLING DATE :
4„co LEDGEND
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DE ELECTRICAL
WJM WATER METER 4
6'4 4. , $o CLEAN—OUT '0'x
`��', 3.3 _ / POWER POLE
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4"$.b10 I i % STORM DRAIN "
Si DEEP 714. $'Q0 HYDRANT _
Cr. CENTERLINE • ` "
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DASHED LINE WITH*1 -
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EMERGENCY EGRESS REQUIREMENTSSA ee.i.Q
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ENING: 5.7 SQUARE FEET ekir
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3)NET CLEAR OPENING WEIGHT
20 INCHES
24 INCHES
4)MAX FINISHED SILL HEIGHT
5)EMERGENCY ESCAPE&:ESCUE OPENIN ell>Vb
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THE USE OF KEYS OR TOOLS '�i+ e 4,0.1414%*
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