2005, 08-15 Permit Application: 05002926 Tear Off, ReroofBUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division,
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
T ' .. Phone: (509) 685 -0036; Fax: (509) 663 -0037
REQUIRED SITE INFORMATION
Street Address: O /G
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: (0,CJ, • TE-CK C Per -nit ❑ Change in Use ❑ Grading n Manufactured Home
Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
11
OWNER/APPLICANTLNFORMATION
ErV Owner. (1 \O rd 1(, 0 /Applicant: -
Phone: Fax: Phone: Fax:
Address: SDZ,(/ S. tjE� c.6 • Address:
State 1 ip Code City State Zip Code
n Contractor: ❑ Architect:
Phone: Fax: Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
• WA State Contractor License #: Contact:
Spokane Valley Bus. Liscense #: Contact:
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 0_,P F OJECT,o_
(>4 (0) CO
30% SLOPES ON PROPERTY:
SEWER OR ON -SITE SEPTIC
SYSTEM?
i
► ?OU SC.
MANUFACTURED HOME
Width:
Length: Year
Manufacturer.
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
=ire Sprinkler. # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: DatefTime:
Jaluation: Above /Underground Storage Tank Size:
WASHINGTON STATE NON - RESIDENTIAL ENERGY CODE
Plans Examiner.
address:
Phone:
Fax:
City
nspector. Phone:
5,ddress:
State
Fax:
Zip
City
State Zip
SPECIAL INSPECTIONS
BOLTING ❑ CONCRETE
❑ REINFORCEMENT ❑ WELDING
=irm Name: Phone:
nspector(s):
Fax:
)ISCLAIMER
The 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
property 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 any issued permit i 4 re o th
'rint Name Del 'K elY )0/ . D V d! 1 Signature
r
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
] Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
sankcard #:
authorized Signature:
Expires:
VIN #: