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:

  • 2 signatures
  • 29 check-boxes
  • 84 other fields

Country of origin: US
File type: PDF

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

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2/26/2020 Page 1 of 2
Along with this application please provide electronic files of the following:
o Drawings / plans with supporting documents
o Any applicable plumbing, mechanical, fire, site improvement and right of way permit applications
All businesses which perform work in the City must have a current Business License. If the business is located
outside of the City, the license must have a City of Liberty Lake Endorsement.
ADD CHECK MARK NEXT TO THE APPLICANT’S INFO
Property Owner’s Name:
Email: Phone:
Address: City, State, Zip:
Contractor’s Business & Owner’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:
Construction Financing Lender or Bond Firm’s Name (if applicable):
Email: Phone:
Address: City, State, Zip:
Project Contact’s Name:
Email: Phone:
Site Specific Information
Project Address: Assessor’s Tax Parcel:
Estimated Value of Project: Estimated Sq Ft:
Project Description: (please describe in detail the scope of work)
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)
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
2/26/2020 Page 2 of 2
Multi
Fami
ly Residential
(if applicable)
# of Units: # of Stories: Site Zoning: Adjacent Zoning:
The permit becomes 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.
Required Signatures
BY SIGNING BELOW (WITH ELECTRONIC SIGNATURE OR PHYSICAL SIGNATURE), I ACKNOWLEDGE THAT A MINIMUM OF 24
HRS. NOTICE IS REQUIRED FOR ALL INSPECTION REQUESTS. I ACKNOWLEDGE THAT I HAVE READ AND ACCEPT THE
REQUIREMENTS LISTED ABOVE AND I GIVE PERMISSION FOR USE OF MY ELECTRONIC SIGNATURE ON THE
PERMIT AND I ACKNOWLEDGE, UNDERSTAND AND AGREE TO THE TERMS DESCRIBED ON THIS APPLICATION.
Property Owner's Signature Printed Name Date
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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