2005, 03-15 Permit App 05000732 Demo Residence, BarnSpokane
.000Ualley
(7,-
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
REQUIRED SITE INFORMATION
3/II/v3-
Street Address: j3 6 (8 G, g 1- A 4v .. ,S�a �co-,.e VA. 11c7 WA- q 2 (1 A.lcP)Ace
Assessor's Tax Parcel Number(s): 45 224. oS3 l e 4S 22 1. o $ 3
Legal Description: SF 4 ,Sa c. f , t)n 22 nor.-J �► 6 Aideri'‘ Ae 4-4
PERMIT DESCRIPTION: Ocr"v Gx,`s}.rj re : (I�tn�,u �o 1 arr\
El Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Tenant Improvement ❑ Fire Safety El Other
❑ Relocation
OWNER/APPLICANT INFORMATION
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Owner: qo F(wy,14me oc,,t,l op + El Applicant:
Phone: clam- 51. i Z Fax: 6 4 -463 b Phone:
Sci."- e
04 1e,C4
Fax:
Address: l6it+ B. 4 S :h 200 Address:
S o 1c.L,, e. VA-1 4-/ w� gat i 6
City State Zip Code City
State Zip Code
❑ Contractor: Asp."( C.a,-.14)•;,,c,i;,,,, ,X1.4.. ❑ Architect:
Phone:ezo) 762- ff37 , Fax: Cuis 772- 2,441 Phone: Fax:
Address: 6b by /V: Cov-crAiwz,4- L' Address:
C tt..' 01�A-leAc DID wsis
City State;�� �� .,hU2ip Code City
WA State Contractor License #:
Contact:
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2"' 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:
30% SLOPES ON PROPERTY:
SEWER OR ON -SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Width:
Manufacturer:
Length: Year: Pit Set:
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
Inspector: Phone: :Fax:
Address:
•
Zip
City
.State
Zip
SPECIAL INSPECTIONS'
❑ BOLTING
Firm Name:
❑ CONCRETE ❑ REINFORCEMENT
Phone: . Fax:
Inspector(s):
❑ WELDING
•
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 re �I(ting developmen
t rights granted by any issued per rnit.*nure to t - aro•erty owner.
Print Name l `�-(, Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #:
Authorized Signature:
Expires:
VIN#: