2004, 07-22 Permit App: BLD-04-07160 Reroof11
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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: (o /3 ,U.. ,'- C("3,
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: IRE - R o o F
Building Permit
Relocation
OvEf 1 LivER
❑ Change in Use ❑ Grading ❑ Manufactured Home
0 Tenant Improvement* ❑ Fire Safety ❑ Other
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OWNER/APPLICANT INFORMATION
L.(,),9/..6 0, Sefiui 8�9 mom T--Go,r7EEe
❑ Applicant:
Phone:
Owner: - A-,2kF R, -7-kus-s77
Phone: Fax:
Address: 0 AI, P N g R j
��kRni
1./U/9 99200
City State Zip Code
Address:
Fax:
City
Contractor: F eo,u5-r uc�Tio�
(�o� � ❑ Architect:
Phone: ) �'z4-2i(.., Fax: (�oq)y-Zi_2/6,4 Phone:
Address: oZ 3 sz.i 9 E . ,3 o cAJ - A ✓
CityStateL KE ateto."9 99oi9
Zip Code
State Zip Code
Address:
Fax:
City • State
WA State Contractor License #:9}62 ,t} — Contact: ,-/E,v, '
Zip Code
PERMIT/BUILDING_INFORMATION
HEIGHT TO PEAK
11
MAIN FLOOR TO SQ. FTG:
FINISHED BASEMENT SQ. FTG:
OCCUPANCY GROUP:
# OF BEDROOMS:
DIMENSIONS:
2"" FLOOR SQ.
GARAGE SQ. F
CONSTRUCTIO
COST F PROJECT:
49q 9
TOTAL HABIT
30% SLOPES 0
# OF STORIES:
FTG:
UNFIN BASEMENT SQ. FTG:
rG:
DECK/COV. PATIO SQ. FTG:
N TYPE:
•
HEAT SOURCE:
3LE SPACE:
IMPERVIOUS SURFACE AREA:
N PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Width:
Manufacturer:
Length: Year: Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm:
Tent:
Valuation: Above/Underground Storage Tank Size:
Paint Booth:
Fireworks Display: Blasting: Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
Fax:
City State
Inspector: Phone: Fax:
Address:
Zip
City
State Zip
SPECIAL INSPECTIONS
El BOLTING ❑ CONCRETE
❑ REINFORCEMENT ❑ WELDING
Firm Name: Phone:.
Inspector(s):
Fax:
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 inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard).
❑ Cash ❑ Check ❑ Mastercard 0 VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature: