2005, 08-11 Permit App: 05002885 ReroofDtJSLCJi1VV rLRFYi11 I F ...ivt-11IL:. a uovA�ttiva1r��..1
Scn1po - City of Spokane Valley Community Development Depa tmem
Building Division
5 11707 E. Sprague Avenue, Suite 106
Valley g -- Spokane Valley, WA 99206
Phone: (509) 6$3-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: 2'O C- 54-. Gltiaw 1 e -t Z cJ
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: 412 7 e ' 6,64 i- e. -d.oa f
Building Permit ❑ Change in Use El Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety (1 Other
OWNER/APPLICANT INFORMATION
❑ _Owner f4 ; c 1J 'F2 A t.D ❑ Applicant: S'a-r/- e- .
Phone: 21(0- / /093 Fax: Phone: Fax:
Address: ec' r- i. ci-• Clam.,'Le-c ad , Address:
,oa ..1 c d�lfy APA • ?903 7-
1ty State Zip Code City State Zip Code
❑ Contractor: N-e-vvt.e_ Opti,-te-e ❑ Architect:
Phone: Fax: Phone: Fax:
Address:
Address:
City State Zip Code City State Trp Code
WA State Contractor License #:
Contact:
Spokane Valley Bus. Liscense #: Contact:
PERMJT/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 GOV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
1 cie0 w=
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Nidth:
Manufacturer.
Length: Year
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
=ire Sprinkler.
Fent:
# of Heads: Fire Alarm:
Paint Booth:
Fireworks Display: Blasting: Date/Time:
Jaluation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner.
address:
Phone:
Fax:
City State
nspector. Phone: Fax:
kddress:
Zip
City
State
Zip
SPECIAL INSPECTIONS
BOLTING ❑ CONCRETE
=irm Name:
❑ REINFORCEMENT
Phone:
Fax:
nspector(s):
❑ WELDING
)1SCLAIMER
-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
ransaction. 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.
)wnership of resulting development rights granted by any issued permit inure to the property owner.
'rint Name 14 i C— i RA -1V Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
] Cash ❑ Check
sankcard #:
Luthorized Signature:
0 Mastercard
0 VISA
❑ Other
Expires: VIN#: