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2004, 09-10 Permit App: BLD-04-07629 Reroof*lane 4,00Valley '29( - • BUILDING PERMIT APPLICATION WO City of Spokane Valley Community Development Department Building Division 11707. E. Sprague Avenue, Suite 106 • • Spokane Valley, WA 99206 Phone: (509) 6880036; Fax: (509) 588-0037 REQUIRED SITE INFORMATION' • • ti Street Address: )) a Ni kL1--1 k, s F0)2-141, 016\frA Assessor's Tax Parcel'Number(s): Legal Description: s. q 90 PERMIT DESCRIPTION: ❑ Building Permit ❑ Change in Use ❑ Grading 0 Manufactured Home ' ❑ Relocation ❑ Tenant Improvement ❑ Fire Safety . D Other OWNER/APPLICANT INFORMATION Owner: 1ZIC}1AOD A 1-1 `6M0 Phone: 9a4 3$1/ Fax: • Address: `).D,, \vI AL1 () L GIU-1\t*\1P.,Lt w eft 0:?,"-) City • State Zip Code City State Zip Code ❑ Contractor: ' • ❑ Architect: Phone: Fax: Phone: Fax: Address:* Applicant: Phone: Fax: Address: Address: City State Zip Code City . State . Zip Code WA State Contractor License #: Contact: PERMIT/BUILDING ..INFORMATION HEIGHT TO PEAK ' DIMENSIONS: # QF STORIES:, MAIN FLOOR TO SQ. FTC: • eu'FLOOR SQ: FTG: •JNFIN4 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: '30% LI Do. o� SLOPES O[ 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: Fireworks Display: Blasting: Valuation: . Above/Underground Storage Tank Size: Paint.Booth: 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 ❑ BOLTING 0 CONCRETE Firm Name: 0 REINFORCEMENT Phone:. Inspector(s): Fax: ❑ -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) AGI construction is to, be done in full compliance with the City of Spokane Valley Development Code. -Referenced codes are available for review of the City of Spokane Valley Permit Center, 5) This City of:Spbkane 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 0 Cheek . ❑ Mastercard . ❑ VISA 0 Other Bankcard #: Expires: VIN#: Authorized Signature: