2005, 08-17 Permit App 05003001 Pole Barnalley
BUILDING PERMIT APPLICATION WORKSHEE k
tit of Spokanee Valley Community Development Depa tmeni
ij E 1111 n\ " 3 T ( Building Division,
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
one: (509) 683-0036; Fax: (509) 688-0037
REQUIRED SITE
RMATION
Street Address:
/0S03
Assessor's Tax Parcel Number(s):
Legal Description: f
PERMIT DESCRIPTION: / �Y /
aX /! 22 1 �i�✓
Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ _Owner. 'it)IyAl A cLc.ii
Phone: q.2y_ ? Fax:
Address: /9 570,3 %. t-
Ci / v!� f State i ZipCode
❑ Contractor:
Phone: ?%a -4 Fax: 3,2s —CS'
Address: -$-Z //) s7I e, - S
Ci State Zip Code
❑ Applicant: MC_ ,s7e. `z
Phone: 7jo Fax: sw
Address: 5 3_2 q ,v 7r2./o)S
A1, 99 .
State Zip Code
❑ Architect:
Phone: Fax:
Address:
City
State Zip Code
WA State Contractor License #:/t)le _0 8 `758kontact:
Spokane Valley Bus. Liscense #: Contact:
PERM1TIBUILDING INFORMATION
HEIGHT TO PEAK: .,_..r
/
DIMENSIONS: • ,
X,. `/ ,Y /0
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2"" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG: 7,10
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:p�P
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT: 9 pp c,
d
30% SLOPES ON PROPERTY:
SEWER OR ON -SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Nidth: Length: Year Pit Set:
Manufacturer:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
=ire Sprinkler. # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: Date/Time:
Jaluation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Tans Examiner:
address:
Phone: Fax:
City State Zip
nspector. Phone: Fax:
ddress:
City
State Zip
SPECIAL INSPECTIONS
2 BOLTING ❑ CONCRETE
❑ REINFORCEMENT ❑ WELDING
=irm Name: Phone: Fax:
nspector(s):
)ISCLAIMER
-he permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
Welling, 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.
eferenced 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 development rights granted by an issued permit in
t Name 1 L%l..) 1. ,¢f✓7- ignature
to the p
.-e
rty owner.
/lethod of Payment: (Faxed permit applications will only be accepted with major bankcard)
] Cash
;ankcard #:
authorized Signature:
❑ Check
❑ Mastercard
❑ Other
❑ VISA
Expires:
VIN#:
RUG 18 2005 15:47 FR
TO 3241567 P.01,02
stilts -lie
Nritt
Street Address:
Valley
Ct of•Spokane Valley Community Development Department
C iif II V re OS - ( Building Division
11 l l 11707 E. Sprague Avenue, Suite 106
• Spokane Valley, WA 99206
one: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SI I +RMATION
/fO S E //ceui_
Assessor's Tax Parcel Number(s):
'Legal Description: L/
PERMIT DESCRIPTION: /,Va f /x /0
VED
8 2005
wi��
fro/
%. /IVIrtSI0
Building Permit ❑ Change in Use ❑ Grading
Relocation ❑ Tenant Improvement ❑ Fire Safety
CA
❑ Manufactured Home
❑ Other
OWNER/APPLICANT INFORMATION
❑ .Owner. kra BcLc4ec
Phone: qzy-gb Fax:
Address: /0 5705 A
of r„A./.&,
Crty/ State
❑ Contractor
Phone: ,7/d - s8G Fax 3..?5 —r2y
Address: 1-g-29 i1) .Cr ,,.2.r
Ante-- 1L.).$ 9 P.2oS
Ci State Zp Code
Bp Code
❑ App►icant:/Z/A'C Wi4Z . /t4
Phone: 7/o - QS'3 Fax .R
Address: -r3.2 9 Ai srre�✓s
Architect:
Phone:
Address:
State Zip Code
Fax:
city
WA State Contractor License #:/V4,573B%52flontact: niter
Stale Zip Code
Spokane Valley Bus. Liscense #: Contact:
L
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK /5
DIMENSIONS: X� / /01
Y
# OF STORIES:
MAIN FLOOR TO 5Q. FTG:
2"" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SO. FTG:
GARAGE SQ. FTG: 7o0
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE: >O
•#
HEAT SOURCE:
OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA
COST OF PROJECT: 9 rj Oa
30% SLOPES ON PROPERTY:
SEWER OR ON -SITE SEPTIC
SYSTEM?
6
This site plan is being submitted for the purpose of
obtaining a building permit a's a true and correct
All known property
lines/ imensi of the proposal. wetlands,
lines! beensidentified. hAls structures
indicatedand
are asements
wetlands
haveeep slope _ or erg• ical ar
bodies of water.-
Signed:
Date:
I/
`EJ)
�v�