2004, 10-14 Permit App: BLD-04-07924 Reroof, CP
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BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
solValley
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: e 12 3 2- - -1
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: R k A n (/ p
Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Owner:
Phone:
Address:
Fax:
City
State
❑ Applicant: 012 C 1SC4rf, 4 k7zg 14°by
Phone: q67 - S 7 el Fax:
Address: /1 f2 -J lam` y 4
Zip Code City
❑ Contractor:
Phone: Fax:
Address:
State Zip Code
❑ Architect:
Phone: Fax:
Address:
City State Zip Code City State' Zip Code
WA State Contractor License #:
Contact:
PERMIT/BUILDING INFORMATION
HEIGHT_TQP.EAIC
DIMENSIONS;__ _ .._
#;OF STORIES:
MAIN FLOOR TO SQ. FTG: -
2' FLOOR SQ. FTG:
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:30%
5 e Civ
SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Width:
Length: Year:
Manufacturer:
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler:
Tent:
Valuation: Above/Underground Storage Tank Size:
# of Heads: Fire Alarm: Paint Booth:
Fireworks Display: Blasting: Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner: Phone: Fax:
Address:
Zip
City State
Inspector: Phone: Fax:
Address:
City
State
Zip '
SPECIAL INSPECTIONS
D BOLTING ❑ CONCRETE
Firm Name:
❑ REINFORCEMENT
❑ WELDING
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 availablefor 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.
OwnersTiip`ofresulting development- rights' granted by anyissu'e3petmit frit/1761:ih property awn r.
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: