2005, 08-23 Permit App: 05003063 Tear Off, ReroofBUILDING PERMIT APPLICATION WORKSHEE-i
ne City of Spokane Valley Community Development Departmer
S -LOS Building Division
ll9
11707 E. Sprague Avenue., Suite 105-
a
eY .4 11315 Spokane Valley, WA
Phone: (509) 683-0036; Fax: (509) 688-0037
99205
REQUIRED SITE INFORMATION
Street Address: /6'7-- /14 C Lt.; 7/16
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: Re r evia 01-7f(aa14...e
;ff Building Permit 0 Change in Use 0 Grading 0 Manufactured Home
0 Relocation Tenant Improvement 0 Fire Safety 0 Other
1 OWNER/APPLICANT INFORMATION
ET _Owner ett-e• i aft,a. Set dye.), 0 Applicant: 5a„, .e.
Phone: tix- Sri,'" Fax: — ' Phone: Fax
Address: tor /v. aii•In. Address:
2/f/r.....c_ (14/i..7. L _ 991../ 4
City State 4p Code City State Zip Code
0 Contractor.
Phone:
Address:
5-41.4•
760--A-01— -
Fax
City
0 Architect 0
Phone:
Address:
Fax:
State Zp Code City State Zip Code
• WA State Contractor License #:
Spokane Valley Bus. Liscense #:
Contact:
Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIONS:
# OF STORIES:
/
MAIN FLOOR TO SQ. FTG:
/fag
2' FLOOR SQ. FTG:
-,9-
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
//OP
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
0
OCCUPANCY GROUP:
CONSTRUCTIONLTYPE:
LMS P
HEAT SOURCE:
E4
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
Pl.
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Vidth:
Length:
Aanufacturer.
Pit Set:
RELOCATION
)revious Address:
'roposed Use:
"ire Sprinkler. # of Heads: Fire Alarrn:
"ent:
faluation: Above/Underground Storage Tank Size:
Paint Booth:
Fireworks Display: Blasting: Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
'fans Examiner. Phone: Fax:
.ddress:
City State
lspector Phone: Fax:
ddress:
Zip
City
State
Zip
SPECIAL INSPECTIONS
] BOLTING D CONCRETE
lrm Name:
LI REINFORCEMENT
Phone:.
ispector(s):
Fax:
D WELDING
ISCLAIMER
he perrnitee 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
ansaction. 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 inure to the property owner.
rint Name fi 477 44 ( sty y
Signature
rethod of Payment: (Faxed permit applications will only be accepted with major bankcarcf)
Cash 0 Check 0 Mastercard
ankcard #:
uthorized Signature:
0 VISA
Expires:
Other