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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