2004, 09-07 Permit App: BLD-04-07572 Finish Basement , 106- 95 612/- 17__S-2)-1
,� BUILDING PERMIT APPLICATION WORKSHEET
, POanit City of Spokane Valley Community Development Department
eBuilding Division
19707 E. Sprague Avenue, Suite 106
.40,1/alley • . • • Spokane Valley, WA 99206
• Phone: (509) 688-0036;Fax: 509 688-0037
1 .
REQUIRED SITE INFORMATION` - •
.t
Street Address: /357 . • ij— (5)9. 7L
.
Assessor's Tax Parcel Number(s): . • .
•
Legal Description: - .. •
..
PERMIT DESCRIPTION: fj'v/vl-, . 4155/x.4-5/v77 84�f7 '4// L y- u 0, • e
,,,
❑ Building Permit ❑ Change in Use • D Grading 0 Manufactured H m
0 Relocation 0 Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: , E/C)0 .1--"i71-/E0 Applicant:
• Phone: q(/ /bb. tea : cl'19 r lc1 Phone: . . Fax:
Address: /3s i c , - Address:
City • State Zip Code City ,State Zip Code
0 Contractor: • •❑ Architect: •
Phone: Fax: Phone: Fax:
Address: . - • Address:'
City State Zip Code • City - State Zip Code
WA State Contractor License.#: Contact:
• • • PERMIT/BM DING INFORMATION 1
HEIGHT TO PEAK: • DIMENSIONS: #OF STORIES:•
MAIN FLOOR TO SQ: FTG: ? FLOOR SQ.FIG: UNFIN BASEMENT SQ. FTG:
FINISHED BASEMS* FTC: GARAGE SQ FTG: DECK/COV. PATIO SQ. FTG:
OCCUPANCY GR UP: CONSTRUCTION TYPE: HEAT SOURCE:
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF PROJECT: • • 30%SLOPES ON PROPERTY: 'SEWER OR ON-SITE SEPTIC•
SYSTEM?
•
•
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 Diplay: 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
•
•
0 BOLTING ❑ CONCRETE • 0 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`Spbkane 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 of Payment: (Faxed permit applications will only be accepted with major bankcard).
❑ Cash ❑ Check . 0 Mastercard . • ❑ VISA • ❑ Other
•
• Bankcard#: Expires: • •VIN#:
•
Authorized Signature:
WHEN INTERIOR ALTERATIONS, REPAIRS OR ADDITIONS
REOUIMNG A PERMIT OCCUR, OR TIAs l ONE OR MORE
SLEEPING ROOMS ARE AMMON CREATED WOWING
DWELLINGS, THE DWELLING UIPT MOLL SE PROVIDED
WITH SMOKE ALARMS LOCATED AS REQUIRED POR NIT" I
DIWELLING$.'
EXHAUST FANS
100 CFM kitchen
50 CFM bathrooms
& 'laundry
THESE PLANS THE Sr SE
HE JOB s'rEEpr
VSin ul "PeVu
SISJHS OOl Z81. -Z4 peg leuogeNN