2004, 09-24 Permit: BLD-04-07756 Reroof5li
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11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
RESIDENTIAL ADDITION/REMODEL PERMIT
Job Address: 1107 N CALVIN RD
SPOKANE WA 99216-1995
Description: RE -ROOF
Subdivision:
Owner:
Applicant:
Address:
Contractor:
Address:
CLEMENS, JEFF K
Permit #:
Applied:
Issued:
Expires:
Lot: Blk: Parcel No: 45142.9239
CLEMENS, JEFF K Phone:
1107 N CALVIN RD
SPOKANE, WA 99216-1995
Phone:
Lic No:
BLD -04-07756
Zoning:
09/24/2004
09/24/2004
03/23/2005
General Information:
VALUATION
REROOF
NON -HEATED
COST OF PROJECT
SERVED BY SEPTIC SYSTEM
WELLS LOCATED ON PROPERTY
1000
Y
N
1000
no
no
Fees:
BASIC PERMIT FEE
WSBCC SURCHARGE
Total Calculated:
Deposits/Receipts:
Total Due:
69.25
4.50
73.75
73.75
0.00
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 Spo - - Valley Permit Center. 5) This City of
Spokane Valley Permit is not a permit or approval for any violation of federal, state or loc-I la s, cod: or ordinances.
Ownership of resulting development rights granted by any issued permit inure to talpiff
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Print Name
Staff Initials
THIS IS NOT A RECEIPT
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
Street Address: „rt
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: C=e
1
/E
❑ Building Permit ❑ Change in Use [1 Grading ❑ Manufactured Home
❑ Relocation n Tenant Improvement ❑ Fire Safety cOther
OWNER/APPLICANT INFORMATION
C
Owner:
Phone:
Address:
City
State
❑ Applicant:
Phone:
Address:
Fax:
Zip Code City
❑ Architect:
- Phone: Fax:
❑ Contractor:
Phone:
Address:
Fax:
City
State Zip Code
State Zip Code
Address:
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 P OJECT:
451"C91,
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
Check ❑ Mastercard ❑ VISA
Expires:
❑ Cash
Bankcard #:
Authorized Signature:
sff/
VIN#:
❑ Other