2005, 08-16 Permit App: 05002969 Garage Addition BUILDING PERMIT APPLICATION WORKSHEET
iTtl` kane Cit of Spokane Valley Community Development Department
G Building Division.
H �- ��'•I 11707 E. Sprague Avenue, Suite 106
T Spokane Valley, WA 99206
" Y. ') Phone: (509) 683-0036; Fax: (509) 688-0037
a *-2-c \r 4,,
REQUIR .co. IINFQMATION
Street Address: /327-c ,),-7 4`' L ' :'
Assessor's Tax Parcel Number(s): 0 �`
Legal Description:
o °%
)PERMIT DESCRIPTION: ; Triv/) 7,',.9/z9 069/7 4 f 70 �t"V&-- c F/<f0_
❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ _Owner. Di -----e/te`c'''i ❑ Applicant: •
Phone: Fax: Phone: Fax:
Address: /32 z e) E ZZNO Address:
5ô/(-4N&--- 'Aict7 vs!k 9 9 z
City State Zip Code City State Zip Code
Vii Contractor: /e4ReAry 6-,i-7 s i -1-"%v Cv c ❑ Architect:
Phone: y, ,1-y-vY Fax: yy�-7 ‘-/ Phone: Fax:
Address: ` " " 'G' L/o i G 4. 4 z-- Address:
5 ),20,rc/j•ic-- vv cr c Z3
City State Zip Code City State Zip Code
• WA State Contractor License #: /eAge., ALt)V'KP Contact: Ai<< kti0 L. s
Spokane Valley Bus. Liscense #: Contact:
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:
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
/7; e.)01) SYSTEM?
(40 c) ao2 y
MANUFACTURED HOME
Nidth: Length: 'rear. Pit Set:
Manufacturer:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
=ire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
rent: Fireworks Display: Blasting: Date/Time:
✓aluation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
'tans Examiner: Phone: Fax:
address:
City State Zip
nspector. Phone: Fax:
kddress:
City State Zip
SPECIAL INSPECTIONS
BOLTING ❑ CONCRETE ❑ REINFORCEMENT ❑ WELDING
=irm Name: Phone: Fax:
nspector(s):
)ISCLAIMER
-he perrnitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
swelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
>roperty owner. 3) The signatory is the property owner or has permission to represent the property owner in this
ransaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Zeferenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
'ermit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
)wnership of resulting veloprnen�t rights granted by any issued permit i re t. )1 property own
'rint Name i 42L Signature
4ethod of Payment: (Faxed permit applications will only be accepted with major bankcard)
] Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
sankcard#: Expires: VIN#:
authorized Signature: