2005, 08-08 Permit App: 05002790 Reroofskrne
Dalley
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City of Spokane Valley Community Development Departmen
Building Divisior,
- 2 J 1 11707 E. Sprague Avenue, Suite 106
1) Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: (Zl✓O �ta ✓w V- i J /04 GI /7.4 v(
Assessor's Tax Parcel Number(s): ( qoia
Legal Description:
i Cc 'L:��
PERMIT DESCRIPTION: Z_e 1AT i /L)(l�` -✓ mL� •�;� l
❑ Building Permit ❑ Change in Use❑ Grading ❑Manufactured Home
0 Relocation 0 Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
_Owner.'-Tc,tI A {- AC->I(.4l«I St.► n FCi..M. Tikh1 ❑ Applicant:
Phone:Zdt qt,Y 3 el Fax: j ;. s Phone: Fax:
Address: / _ Address:
GSA- C /(5D % 3 6=)
ty t State Zip Code City State Zip Code
❑ Contractor:
Phone:
Address:
Fax:
City
0 Architect:
Phone:
Address:
Fax:
State Zip Code City State Zip Code
• WA State Contractor License #:
Contact:
Spokane Valley Bus. Liscense #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2"" FLOOR SQ. FTG:
UNF1N BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECK/GOV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT: _ 2 /6, `s -u30%
SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM? .
MANUFACTURED HOME
J'idth:
•
Length: Year
Manufacturer.
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
=ire Sprinkler.
Tent:
# of Heads: Fire Alarm:
Paint Booth:
Fireworks Display: Blasting: Date/Time:
✓aluation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner.
address:
Phone:
Fax:
City State
nspector. Phone: Fax:
address:
Zip
City
State
Zip
SPECIAL INSPECTIONS
BOLTING ❑ CONCRETE
=irm Name:
❑ REINFORCEMENT
Phone:
nspector(s):
Fax:
0 WELDING
)1SCLAIMER
-he perrnitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
swelling, 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 ocal laws, codes or ordinances.
)wnership of resulting development rights granted by any issued Rermin, - to the property owner.
Print Name n c) v n Signature ih
NW/
/lethod of Payment: (Faxed permit applications will only be accepted with major bankcard)
1 Cash
;ankcard #:
uthorized Signature:
❑ Check 0 Mastercard
0 VISA
Expires:
VIN#:
❑ Other