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2004, 06-15 Permit App: BLD-04-04614 Carport BUILDING PERMIT APPLICATION WORKSHEET Siokane City of Spokane Valley Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 dosiscValley Spokane Valley, WA 99206 Phone: (509) 688-0036;Fax; 509 688-0037 Fax: (509) REQUIRED SITE INFORMATION Street Address: / 27 /( E. 2-STti S Po A"-live (/'c, //r Assessor's Tax Parcel Number(s): (--1 .. 7 3 . ;)3 o 2 Legal Description: PERMIT DESCRIPTION: 0 Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home ❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other OWNER/APPLICANT INFORMATION © Owner: L k`r ii S'c L Pi ilt 0 Applicant: L ci fk r �/ S cX.0,(-T 16 n�q Phone: ' Fax: Phone: i Z r -i'29 Fax: Address: 1 .27 /6 i- 25Tk Address: t2—)/c zrr� SPG k4Nc I/ct //lY , kva. q '? 2!t! S'" ka ' Ilk Ile?' 1 Wel 9'4 Z Ii City State Zip Code City State Zip Code LI Contractor: ❑ Architect: Sq ,' e 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: , �i DIMENSIONS: d )( /5 ' #OF STORIES: U MAIN FLOOR TO SQ. FT .33. 2""FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: y. FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECKICOV. PATIO SQ. FTG: OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE: C elk, l'0 e7- #OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA: COST OF PROJECT: 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC SYSTEM? S'c iy er 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: nspector(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 permit inure to the property owner. i-f f. Print Name 46y // S c h , ""]"' O tia,Signature !� �cv �,4j Method of Payment: (Faxed permit, •lications will only be accepted with major bankcard) Q` El Cash ❑ Check m Mastercard ❑ VISA ❑ Other Bankcard # �ires� VIN#: This document originally contained Authorized Signature: c AA, '. confidential credit card information which wab redat.ced pursuant to RCW 19.255.010 and the original document destroyed pursuant to SOS DAN GS2014-030. 4. . , stA i11 ( 2..0* , alit ts \\ ..\(...v,41. cpr.c-e.s a. This site pan_is being subittided ter tee ZONE i Al"ESSROADWIDT/4 1 FLANIONG------ obtaining a owning permit and is e true and"WillederreotIM ir,eneprsemseininensiotetionnsotcithirbe unispropeelli.shuiqunts. Alf hnOwninde • • a havis been identdied• . Also indicated ale F RONT bodies ot tvlder steep Nom or Other Orals: COMMENTRENIIEWED : *IN IA ,'t ..... Signed: ' 4.• 1-...4.... 4 Date: '- (T‘-,o • 1)164 Qrt\) ) ) \ I C'IS, / ---...,.., ••••*.R.1.100.....14.RIONIINIMPI.•••**/*•••••.•44..m.s••••••, •• • //f/ /3 1 ! t.' (I ti1 \IVA te /./ 14. slS k. Hi \// 4 / il <A q cla k , ...-- 3. ko r it. r r to ...._ / 0 0I •:,