2005, 06-10 Permit App: 05001988 Tear Off, ReroofProject Number: 05001988 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 06/10/2005 Page 1 of 2
Project Information:
Permit Use: TEAR OFF AND REROOF RESIDENCE Contact: ARNOLD, HAROLD
Address: 2214 N DORA RD
C - S - Z: SPOKANE VALLEY, WA 99212
Setbacks: Front Left: Right: Rear: Phone: (509) 924-2896
Group Name:
Site Information: Project Name:
Plat Key: 000098 Name: ASSESSORS PLAT # 01 District: Nort
Parcel Number: 35124.0403 Block:
SiteAddress: 2214 N DORA RD
Location:: CSV
Zoning: UR -3.5
Water District:
Urban Residential 3.5
Lot:
Owner: Name: ARNOLD, HAROLD
Address: 2214 N DORA RD
SPOKANE VALLEY, WA 99212
Hold: ❑
Area: .00 Acres Width: 0 Depth: 0 Right Of Way (ft): 50
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information: y e
Permits:
Contractor: OWNER
Building Permit
Firm: OWNER
Phone: (000) 000-0000
This Application: Total Project:
Description Grp 1pe Notes Sq Ft Valuation Sq Ft Valuation
RESIDENCE R-3 VB TEAR 0 $2,000.00 0 $2,000.00
OFF/REROO
F
Item Description
RESIDENTIAL PERMIT FEE
STATE SURCHARGE
Totals:
0 $2,000.00 0 $2,000.00
Units Unit Desc Fee Amount
1 SELECT $69.25
1 SELECT $4.50
Operator: K_C Printed 13y: MT
Permit Total Fees: $73.75
Print Date: 06/10/2005
Prdj ect Number: 05001988 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 06/10/2005 Page 2 of 2
Notes:
Payment Summary:
Permit Type
Building Permit
Fee Amount Invoice Amount Amount Paid Amount Owing
$73.75 $73.75 $0.00 $73.75
$73.75 $73.75 $0.00 $73.75
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: K_C Printed 13y: MT Print Date: 06/10/2005
Spokane
doiUalley
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
6� c g2 Building Division
19707 E 1
Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: A7 22 /
1.
Assessor's Tax Parcel Number(s): 357.24, 04.03
Legal Description: 4cSF_ 55oo2S) I% PM SBFT .G &Al/l Lsj X33
PERMIT DESCRIPTION: ! TERD.04 n/G - exist i.c/c. /IOMF (-MN o KF)
rl Building Permit
❑ Relocation
❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Tenant Improvement 0 Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION =-
Owner. A .gpo,(ci/ ARAJnlrf 0 _,` Applicant:
"Phone: 9E4-:2394 -Fax: - Phone: • Fax: '-h.'Ir:
Address: •71 22 /5<�oEa ! - Address:
--CpcskA.vF ✓Jit' -y 4/4-rr.?�Jz
city / State Zip Code City State . Zip Code
• 0 Architect: ,..
Phone: Fax: Phone: • • Fax: -;N.,..:,•
0 • :Contractor:
_ Address:
City
- State Zip Code _
Address:
City
WA State Contractor License #: Contact:
Spokane Valley Bus. Liscense #: Contact:
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2"u 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 OF PROJECT:
2One)-%
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Width:
Manufacturer:
Length: Year Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler.
Tent:
Valuation: Above/Underground Storage Tank Size:
# of Heads: Fire Alarm: Paint Booth:
Fireworks Display: Blasting: Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
•
Plans Examiner:
Address: . .
Phone:
Fax:
_ , Inspector: -
City .
-. Phone:
.:.State
Fax: i!:..;7J. ,-:; or
Address: - - ':•
..." a s:
Zip
-City
' - State
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
Firm Name: Phone: Fax:
Inspector(s):
9 REINFORCEMENT
❑:WELDING•
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 Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
Ownership of resulting development rights granted by any issued permit in re to the property ow Jr.
Print Name'IyARo lel (c Ave, Ar) Signature lir ,As—c.."
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature: