2004, 07-01 Permit App BLD-04-07003 MH*lane
Valley
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
Street Address:
/9 fzc rk- 4/4
Assessor's Tax Parcel Number(s):
Legal Description: 4/ �' O
PERMIT DESCRIPTION: Sc ,p,,,, Sa�
Building Permit ❑ Change in Use ❑ Grading J Manufactured Home
E Relocation ❑ Tenant Improvement ❑ Fire Safety C Other
. ❑ Owner:
Phone: • Fax:
Address: 950.5- E, A-yre
5`pa /Grp, o /,Ufa if i
City State
Zip Code
❑ Contractor. *21Me //„
Phone: 53s /773 Fax:
Address: 4'5b 5
-5 n /crcie-e G/2,4t
City State
/7 c
❑ Applicant: ,a,„0/'
Phone: 95,5322 3 Fax: 927-6757
Address: ,A/5 CPy�,o/„77„
/p.L/a ///* f5br
Ci (/ State Zip Code
❑ Architect:
Phone:. Fax:
Address:
City
State
WA State Contractor License #: Contact:
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: /3 CA
DIMENSIONS: 2ect3 r, X (04c,04
# OF STOREES: /
MAW FLOOR 'TO FTG:
2"" FLOOR SQ. FTG
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT ��TG:
GARAGE SQ. FTG:
DECK(COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS: 3
TOTAL. HABITABLE SPACE:
EMPERVEOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
'SEWER R ON -SITE SEPTIC
S ? S S.
MANUFACTURED HOME
Width: Zia S( Length: (p yC-Year. za / Pit Set Ve
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:
Address:
•Phone:
Fax:
City
Inspector: Phone:
Address:
State
Fax: -
Zip
City
State
Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
Firm Name:
❑ REINFORCEMENT
Phone:
Fax:
E WELDING
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 permit inure to the property owner.
Print Name IO��`'/�Q yl Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash - ,Check ❑ Mastercard
Bankcard #:
Authorized Signature:
❑ Other
VIN#:
0 VISA
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