2005, 08-03 Permit App: 05002693 Tear Off, Reroof ` - BUILDING PERMIT APPLICATION WORKSHEETCity of Spokane Valley Community Development Department
-31)oha ' 0Building Division
11707 E. Sprague Avenue, Suite 106
Y
,...,4,-f-14.--. ? Spokane Valley, WA 99206
`� ( _) - � � Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: / 71? /q_ 12Cr t`t ie.(4,9,
Assessor's Tax Parcel Number(s):
Legal Description: —72--/4 vz 04- - Re - R 74
Cb PERMIT DESCRIPTION:
iBuilding Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
po ❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
O-
N OWNERIAPPLICANT INFORMATION
610 ❑ Owner. i-rmi K- ,Dc=/A y❑ Applicant: /3/21/A/4 ��rc, •
Phone: Fax: Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
,Er Contractor: I‹,,r3C Cot,--0-Ivz_tx.i toi,4 ❑ Architect:
Phone:5vii-c48-3 y i 3 Fax:so-t-Liss-2(0:3--Z Phone: Fax:
Address: - --70-3 C 10‘,0_-1-/Af-ed Address:
Citi State Zip Code City State Zip Code
• WA State Contractor License#: .Ae c cx„K,,./ Contact: 73 vz 1A« r,tic H
Spokane Valley Bus. Liscense #: Contact
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: 32- DIMENSIONS: #OF STORIES: 3
MAIN FLOOR TO SQ. FTG: 2""FLOOR SQ. FTG: ISU UNFIN BASEMENT SQ. FTG•
2-(t00FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
/SOO
OCCUPANCY GROUP: CONSTRUCTION TYPE: . HEAT SOURCE: C�
S, $.tc,IG 04I/I l au,ad/3lko,✓ S4icGk T/1,n^ (--)(^ AS
#OF BEDROOMS: L j TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF PROJECT: - cr 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
SOCA SYSTEM?
MANUFACTURED HOME
Nidth: Length: Year: Pit Set:
Manufacturer:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
=ire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
rent: Fireworks Display: Blasting: Date/Time:
✓aluation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner: Phone: Fax:
address:
City State Zip
nspector. Phone: Fax:
kddress:
City State Zip
SPECIAL INSPECTIONS
BOLTING ❑ CONCRETE ❑ REINFORCEMENT ❑ WELDING
=irm Name: Phone: Fax:
nspector(s):
)1SCLAIMER
rhe 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
ransaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Zeferenced 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.
)wnership of resulting development rights granted by any issued permit inure to the property owner.
'rint Name /3/2/AM ,A i'c ii Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
] Cash ] Check ❑ Mastercard El VISA ❑ Other
>ankcard#: Expires: VIN#:
authorized Signature: