2004, 04-09 Permit App: BLD-04-04041 Reroof BUILDING PERMIT APPLICATION WORKSHEET
i
TE6kane City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
.0,00Vall . Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: 3- IC)0 3U Q • /
Assessor's Tax Parcel Number(s):
Legal Description: 1O 001)
PERMIT DESCRIPTION: re - r0 \k► \' V
Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation 9 Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
I Owner: LyNK, i\oz.A - . ❑ Applicant:
Phone: Fax: Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
,1 Contractor: 0_1A-- ❑ Architect:
Phone: Cyc )s--1S-Fax: Phone: Fax:
Address: S. • ) I\ ;1Z Address:
City State Zip Code City - State Zip Code
COr�1��
WA State Contractor License #: Ll i� fl rn yl X l�(►Contact: 1 1 e
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
MAIN FLOOR TO SQ. FTG: 2""FLOOR SQ. FTC: UNFIN 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:4n 30%SLOPES ON.PROPERTY: SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Width: Length: Year: Pit Set:
Manufacturer:
RELOCATION
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:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner: Phone: Fax:
Address:
City State Zip
Inspector: Phone: Fax:
Address:
City State Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE El REINFORCEMENT ❑ WELDING
Firm Name: Phone: Fax:
Inspector(s):
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) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane 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)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
LICENSE DETAIL INFORMATION Form Page 1 of 2
STATE OF WASHINGTON
DEPARTMENT OF LABOR AND INDUSTRIES
Specialty Compliance Services Division
P. O. Box 44000 Olympia,WA 98504-4000
THE RESULT OF YOUR INQUIRY FOR LICENSE NUMBER SELECTED IS:
LICENSE DETAIL INFORMATION
Current Filter: None
Registration#or License CWHOMH*968C3
Name C W HOMES
Address S 5002 MORRILL LANE
Address
City SPOKANE
State WA
Zip 99223
Phone Number 5099981575
Effective Date 2/23/2004
Expiration Date 2/23/2006
Registration Status ACTIVE
Type CONSTRUCTION CONTRACTOR
Entity CORPORATION
Specialty Code GENERAL
Other Specialties UNUSED
UBI Number 602250107
'VIEW*VIEW CROSS REFERENCE FILE FOR THIS LICENSE* * *
* * *VIEW PRINCIPAL OWNER(S) FOR THIS LICENSE* *_*
'VIEW*VIEW CONTRACTOR BOND/SAVINGS INFORMATION * * *
'CHECK*CHECK INQUIRY FOR SUMMONS AND COMPLAINTS* * *
* * * VIEW CONTRACTOR INSURANCE INFORMATION * * *
New inquiry by CITY , NAME , PRINCIPAL OWNER NAME , LICENSE , UBI.
NUMBER,check the
L&I Contractor Industrial Insurance Premium Status or return to the L&I Construction
Compliance Home Page
https://wws2.wa.gov/lni/bbip/TF2Form.asp?License=CWHOMH*968C3 4/9/2004