Fillable COMMERCIAL BUILDING PERMIT APPLICATION (City of Liberty Lake)

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COMMERCIAL BUILDING PERMIT APPLICATION (City of Liberty Lake)

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The COMMERCIAL BUILDING PERMIT APPLICATION (City of Liberty Lake) form is 2 pages long and contains:

  • 3 signatures
  • 14 check-boxes
  • 100 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Liberty Lake

BROWSE CITY OF LIBERTY LAKE (WA) FORMS

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02/08/2019 Page 1 of 2
Along with this application please provide the following:
o One electronic copy of drawings / plans with supporting documents
o Any applicable plumbing, mechanical, fire, site improvement an
d right of way permit applications
All businesses which are located in, or perform work in the City must have a current WA State Business License
with a City of Liberty Lake Endorsement.
CHECK ONE BOX BELOW TO INDICATE WHO THE APPLICANT IS
Owner’s Name:
Email: Phone:
Address: City, State, Zip:
Contractor’s Name:
Email: Phone:
Address: City, State, Zip:
WA State Contractor License: Contractor UBI Number:
Architect’s Name:
Email: Phone:
Address: City, State, Zip:
Structural Engineer’s Name:
Email: Phone:
Address: City, State, Zip:
Project Contact’s Name:
Email: Phone:
Site Specific Information
Project Address: Assessor’s Tax Parcel:
Project Description: (please describe in detail the scope of work) Estimated Value of Project:
Special Inspections Required? Yes No (If Yes, please provide the Statement of Special Inspections document)
Are there existing structures on the property? Yes No What is the current property size?
acres sq ft
Is the property within a 100-year flood plan? Yes No Is the property within 250 feet of a shoreline? Yes No
Are there wetlands within 200 feet? Yes No Is there evidence of fill or excavation? Yes No
Are there slopes greater than 30% on the
property (30 ft. rise in 100 ft.)?
Yes No
( ________%)
Are critical or hazardous materials used Yes No
or stored on site? (If Yes, please provide list of materials)
Multi-Famil
y
Residential (if applicable)
# of Units: # of Stories: Site Zoning: Adjacent Zoning:
New Commercial / Industrial Tenant Improvement Multi-Family Residential Other:
COMMERCIAL BUILDING PERMIT APPLICATION
Liberty Lake Planning, Engineering & Building Services
22710 E Country Vista Drive, Liberty Lake, WA 99019
Phone: (509) 755-6704 Fax: (509) 755-6713 Website:
www.libertylakewa.gov
Email: permitcenter@libertylakewa.gov
02/08/2019 Page 2 of 2
Required Si
g
natures
BY SIGNING BELOW, I ACKNOWLEDGE THAT A MINIMUM OF 24 HRS. NOTICE IS REQUIRED FOR ALL INSPECTION REQUESTS
Property Owner's Signature Printed Name Date
Applicant's Signature Printed Name Date
Permit Issuance Option
Would you like to receive your permit / approved plans via email? Yes No
(If yes, please complete the portion below. Once review of your application is complete, we will contact you for credit card payment via phone.)
The permit becom
es null and void if work or construction authorized by the permit is not commenced within 180 days of
issuance or if construction or work is suspended or abandoned for a period of 180 days at any time after work is
commenced, unless an extension is granted. Issuance of this permit does not give the authority to violate any federal,
state, or local laws or ordinances, or the building code regulating construction. Separate permits (building, plumbing,
mechanical, sewer, water connection, electrical, etc.) may be required for work performed on this site. Additional permits
/plans may be required prior to Certificate of Occupancy issuance. Contact SRCAA at 509-477-4727 and/or visit
www.spokanecleanair.org to ensure compliance with air quality regulations. The applicant shall be responsible for
obtaining additional permits/approvals from affected agencies. By checking the box below, I certify that I have read and
understand all of the conditions contained herein and I have the authority to sign on behalf of the applicant. Additionally, I
certify that my signature included on the permit, if done by electronic means, provides the same understanding and
authority as if I had signed the permit in person or writing.
BY SIGNING BELOW, I GIVE MY PERMISSION FOR USE OF MY ELECTRONIC SIGNATURE ON THE PERMIT AND I
ACKNOWLEDGE THAT I UNDERSTAND AND AGREE TO THE TERMS DESCRIBED ABOVE.
Applicant's Signature Printed Name Date
BUILDING INFORMATION (PLANNING, ENGINEERING & BUILDING SERVICES OFFICE USE ONLY)
# of Stories: Peak Height: Total Habitable (sq. ft.):
Main Sq. Ft.: Upper Sq. Ft.: Upper Sq. Ft.: Bsmt. Sq. Ft.:
Deck Sq. Ft.: Cov. Deck Sq. Ft.: Garage Sq. Ft.: Acc. Sq. Ft.:
Occupancy Group: Sewer Purveyor: TI Sq. Ft.:
Occupant Load: Water Purveyor: Heat Source: Gas Electric Other:
Construction Type: Sprinklers: Yes No Lot Coverage %: Zoning:
Front Setback: Rear Setback: Right Side Setback: Left Side Setback:
Designated Stormwater Control Area? Yes No Other Mitigation / Impact Fee Area:
PROJECT VALUE:
Notes and Conditions
Mitigation Category: Sq. Ft.: $ / Sq. Ft.:
Mitigation Category: Sq. Ft.: $ / Sq. Ft.:
Mitigation Category: Sq. Ft.: $ / Sq. Ft.:
Mitigation Category: Sq. Ft.: $ / Sq. Ft.:
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COMMERCIAL BUILDING PERMIT APPLICATION (City of Liberty Lake)

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Completed 3 August 2020

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