2004, 07-30 Permit App: BLD-04-07198 Garage000Valley
•
BUILDING PERMIT APPLICATION WORKSHEET
City of Siiokanh Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
• Spokane Valley, WA 99206
Phone: (509) 688=0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION •
Street Address:
l07a0 E. Lo*
Assessor's Tax Parcel Number(s): Gi 440 ya.? . / fq',o,
Legal Description: yltO.t/ L' S 4 J S a • 4 .Ga d
PERMIT DESCRIPTION: -
® Building Permit ❑ Change in Use ❑ Grading
❑ Relocation
❑ Tenant Improvement ❑ Fire Safety
Manufactured Home
Other
A
OWNER/APPLICANT INFORMATION
❑ Owner: V)ACfor\ evthe'k1
Phone: rug-oia I Fax: 02H-06+410
Address: 167.Z.0 t= y-jth
Sp Kc r Ualuy t.0A. emacia
Cdt State Zip code
Applicant:
Phone:
Address:
Fax:
City
Zip Code
0 Contractor: ' 0 Architect:
Phone: Fax: Phone: Fax:
Address.
Address:
City State Zip Code City -
WA State Contractor License #: Contact:
State
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK I Li / .
DIMENSIONS: a? S / X L/a /
# OF STORIES:-
MAIN FLOOR TO SQ. FTG: I X16
r 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:30e%
-4./rAwe/ /lilt..
SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Width;
Length' Year:'
Manufacturer:
Pit Set:
RELOCATION
Previous Address-
proposed
ddressProposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm:
Tent:
Valuation: Above/Underground Storage Tank Size:
Fireworks Di§play: Blasting: •
Paint Booth:
Date)Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone: Fax:
City
Inspector: Phone:
Address -
State
Fax:
Zip
City
State
. Zip
SPECIAL INSPECTIONS
❑ BOLTING
Firm Name:
❑ CONCRETE ❑ REINFORCEMENT
Inspector(s): _
Phone:.
F
0 WELDING
DISCLAIMER
The permitee verities, acknowledges and agrees by their signature that 1). If this permit is for construction of or on a
dwelling, the dwelling islwill 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 Clty 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:
0)
,1
t
�4/D72Et°_
^v ADORES$ _.
I ZONE ' '
ROAD WIDTH
FRONT
COMMENTS
REVIEWED B
This site plan is being subrn
obtaining a build! filled purpose of
building
n h perms end is a and correct
Tines/dimensions, curb lines, proposal.
known �Ps►ty
have been identified. Also indicated are is
bodies of water t slopes or other critical areas,
Signed:'-- areas.
Date:
7 o.