2005, 08-24 Permit App: 05003078 Tear Off, ReroofBUILDING PERMIT APPLICATION WORKSHEET
CI City of Spokane Valley Community Development Depa tmeni
�`a� Building Division,
11707 E. Sprague Avenue, Suite 105
10i
�5 Spokane Valley, WA 99205
l Phone: (509) 688-0036; Fax: (509) 6683-0037
REQUIRED SITE INFORMATION
Street Address:
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: %o, 1 4-, -7
Building Permit ❑ Change in Use ❑ Grading ❑ M nufactured Home
❑ Relocation 0 Tenant Improvement ❑ Fire Safety Other
OWNER/APPLICANT INFORMATION
0 Owner. e A---i�. �_ Applicant:
Phone: ax: / Phone: Fax:
Address: ,47c1 1/ S Soya .49/.5>e ,s3d - Address:
sy U-eti, 4.1.4 9cn2.9C-
Oty State Zp Code / ' City State Zp Code
Contractor. ( - A /97cateht-; / 0 Architect:
Phone: yp,s «aa 2 Fax: 4'n _ o?. Phone: Fax:
Address: p o /Joy 6.VO Address:
ilia" c.44 g9ca
City State Zp Code City State Zp Code
WA State Contractor License #: G L R oo /f4 To Contact D,c.k G/s'cn-
Spokane Valley Bus. Liscense #: Contact
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 OF PROJECT: r�
3, RCb.
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Vidth:
Length: • Year. Pit Set:
/lanufacturer.
RELOCATION
'revious Address:
'roposed Use:
FIRE SAFETY
ire Sprinkler. # of Heads: Fire Alarm:
-ent:
valuation: Above/Underground Storage Tank Size:
Paint Booth:
Fireworks Display: Blasting: Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
'Ians Examiner. Phone:
Lddress:
Fax:
City State Zp
ispector. ' Phone: Fax:
tddress:
City
Stale Zip
SPECIAL INSPECTIONS
] BOLTING ❑ CONCRETE
❑ REINFORCEMENT ❑ WELDING
irrrl Name: Phone: Fax:
lspector(s):
ISCLAIMER
he permitee'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.
wners
of resulting development rights granted by any,issued permit inure to the property owner.
Int Name A Ary' /006/er a? ignature
rethod of Payment: (Faxed permit applications will only be accepted with major bankcard)
] Cash ❑ Check 0 Mastercard 0 VISA ❑ Other
ankcard #: Expires: VIN#:
uthorized Signature: