2004, 08-13 Permit App: BLD-04-07367 ReroofBUILDING 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: /%7 Q/D 4/%(07/ f%,
Assessor's Tax Parcel Number(s):
Legal Description:
6.
PERMIT DESCRIPTION:
Building Permit ❑ Change in Use ❑ Grading 0 Manufactured Home
• ❑ Tenant Improvement. ❑ Fire Safety 0 Other
Relocation
OWNER/APPLICANT INFORMATION
Owner:
er/ITtS
Phone: g.2.‘-- 36 7 Fax:
Address: a,7>e Q5 a.k.,i/e
City
State
Zip Code
Applicant: r/7 k
Phone:
Address:
Fax:
City State Zip Code
0 Contractor: " ❑ Architect:
Phone: Fax: Phone: Fax:
Address:
City
State
Zip Code
Address:'
City .
State
WA State Contractor License #: Contact:
Zip Code
PERMIT/BUILDING _ INFORMATION
HEIGHT TO PEAK
DIMENSIONS:
# OF STORES:.
MAIN FL OR TO SQ. FTG:
D
` Z"'J FLOOR SQ. FTG:
—
UNFIN BASEMENT SO. FTG:
FINISHED BASEMENT SQ FTG:
GARAGE SQ: FTG:
/c6 0 -
• DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:HEAT
SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
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: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: • Date/Time:
Valuation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone: Fax:
City State
Inspector: Phone: Fax:
Address:
Zip
City
State Zip
SPECIAL INSPECTIONS
D BOLTING 0 CONCRETE 0 REINFORCEMENT 0 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).
0 Cash ❑ Check 0 Mastercard . 0 VISA 0 Other
• Bankcard #: Expires: VIN#:
Authorized Signature: