HomeMy WebLinkAbout2004, 07-22 Permit App: BLD-04-07157 Reroofj�i
Street Address:
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
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
Building -Permit
❑ Relocation
'ell) .
❑ Change in Use ❑Grading
❑ Tenant Improvement ❑ Fire Safety
OWNERIAPPLICANT INFORMATION
Owner: S44La/U
Phone: Fax: r 3
Address:
City State ip Code
❑ Contractor:
Phone: Fax:
Address:
City State Zip Code
❑ Manufactured Home
❑ Other
❑ Applicant:
Phone: Fax:
Address:
City state Zip Code
❑ Architect:
Phone: Fax:
Address:
City
WA State Contractor License #: Contact:
PERMIT/BUILDING:INFORMATIO1
State Zip Code
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2NLFLOOR 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 PR aECT:'
300/6 SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
I MANUFACTURED HOME I
Width: Length:
Manufacturer:
Previous Address:
Proposed Use:
Year: Pit Set:
RELOCATION
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm:
Tent: Fireworks Display: Blasting:
Valuation: Above/Underground Storage Tank Size:
Paint Booth:
Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner: Phone: Fax:
Address:
city State Zip
Inspector: Phone: Fax:
Address:
city state Zip
I SPECIAL INSPECTIONS I
❑ BOLTING
Firm Name:
Inspector(s):
❑ CONCRETE ❑ REINFORCEMENT
Phone:.
Fax:
❑ WELDING
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 'I) 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 inure to the property owner,
Print Name �,li%1�%—Sr�n-0s Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard).
❑ Cash Check ❑ Mastercard . ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
❑ Other