2006, 07-11 Permit App: 06002659 Reroof 07/10/2006 14:25 5094685081 CAPSTONE CONSTRUCTIO PAGE 01/02
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' BUILDING PERMIT APPLICATION WORKSHEET
• ' ' ' ---..- City of Spokane Valley Community Development Department
po Building Division
11707 E. Sprague Avenue, Suite 106
400°Va 11.01
Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: /f” I �-e rf 6
Assessors Tax Parcel Number(s):
Legal Description:
..
PERMIT DESCRIPTION: /
iiilding Permit 0 Change In Use ❑ Grading 0 Manufactured Home
❑ Relocation 0 Tenant Improvement 0 Fire Safety D Other
L 4ficaaallin. OWNER/APPLICANT INFORMATION
•
❑ Owner: Mese-4 ❑ Applicant: •
Phone: .2y— yt Fax: Phone: Fax:
Address: I ,. . _.. ' ,� Address:
ty State Zip Code City State Zip Code
El Contractor: ASTM€ ne Ue oW c❑ Architect:
Phone: 5/1,e-V tl/ Fax: 5i6g-1708'/ Phone: Fax:
Address: Ad.60%. 3Ta Address:
NCiria Hi l e Wks 1.(1,4- 9 Zip Code City ,State Zip Code
• WA State Contractor License#:C}iPSTC ./C(J5 Contact: iv1 aIAJ - �—/-sd..5—
Spokane Valley Bus. Liscense#: .$01/1/ Contact:
•
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
MAIN FLOOR TO SQ.FTG: 214"FLOOR SQ.FTG: UNFIN BASEMENT SQ.FTG:
FINISHED BASEMENT SQ.FTC: GARAGE SQ:FTG: DECK/COV.PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
# OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF PRO CT: fie 30%SLOPES ON PROPERTY: SEWEW1OR 9N-SITE SEPTIC
JUL 10 2006 14:4? 5094685081 PAGE.01
0`7/10/2006 14:25 5094685081 CAPSTONE CONSTRUCTIO PAGE 02/02
1
,L....___ MANUFACTURED HOME
Width: Length: Year: Pit Set
Manufacturer:
RELOCATION ^ 1
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:
l WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner: Phone Fax:
Address:
City State Zlp
Inspector: Phone: Fax:
Address:
. City State Zip
1 SPECIAL INSPECTIONS 1
❑ BOLTING ❑ CONCRETE El REINFORCEMENT ❑ WELDING
Firm Name: Phone: Fax:
Inspector(s):
DISCLAIMER
The permitee verities, 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.
Permit is not ad permit or approval or review at the for any violation of federof al state kane Valley
local laws,codemit er.s or ord ors dinances.
of Spokane Valley
Perm
Ownership of resulting development rights granted by any issued permit inure the property owner.
Print Name .---
h ..5/A-40AlgaAl Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check
Mastercard igiVISA ❑ Other
Aracad1=1.
Q — VIN#: _
- ��� /s:
Bankcard#'
tainpd
Authorized Signature: this—..agionigot---adonav--t"
confidential credit card information which
was redacted pursuant to RCW 19.255.010
and the original document destroyed
pursuant to SOS DAN GS2014-030.
JUL 10 2006 14:48 5094685081 PAGE.02