2005, 08-22 Permit App: 05003044 Tear Off, Reroof BUILDING PERMIT APPLICATION WORKSHEET EET
T - _ City ofSpokane Valley Community Development Department
.
Building Division
OS - -DD- -T 11707 E. Sprague Avenue, Suite 106
---Tx - '4, • -IIS c Spokane Valley, WA 99206
4.
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Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: /4120 7 F, "I 1. ay.,
Assessor's Tax Parcel Number(s): 6-5 Z-5 2 Cl l J+
Legal Description: ,/
Cok•A
PERMIT DESCRIPTION: ( vo,o u c Ko et' RZepQoa?2 t0 /4k Cotr I 'oma, S4•Sis
❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
14 _Owner: Octve -i 0Ct iL{o, t is Applicant: rf�Ii44 ljec.t.�-
Phone: 93/ qaq' Fax: Phone:02-9V e Fax: 292-fsi6?
Address: /i-007 � 6944,6944, a v-c Address: :' se,'3 l ac c. Pd
leo N'e ( W)CC C.L.ti ✓oJ / /+
( J�. . 76 d 3
Ci 6.)
State Zip Code City State Zip Code
UA Contractor: IRA rhe Gieek VLL ❑ Architect:
Phone:)-99c ? Fa ,29)-9c4 7 Phone: Fax:
Address: 5-9J' irz0,v-,: /d Address:
City State Trp Code City State Zip Code
• WA State Contractor License#: Re)coinolin4 g Contact: rgAmg ,^'L
Spokane Valley Bus. Liscense #: Contact:
PERMITIBUILDING 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/COV. PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF PROJECT: 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
'�"i SYSTEM?
MANUFACTURED HOME
Nidth: Length: Year. Pit Set:
Manufacturer. •
RELOCATION
Previous Address:
Proposed Use:
-
FIRE SAFETY
=ire Sprinkler. # of Heads: Fire Alarm: Paint Booth:
rent: Fireworks Display: Blasting: Date/Time:
✓aluation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner. Phone: Fax:
address:
City State Zip
nspector. Phone: Fax:
kddress:
City State Zip
SPECIAL INSPECTIONS
BOLTING ❑ CONCRETE ❑ REINFORCEMENT ❑ WELDING
=irm Name: Phone: Fax:
nspector(s):
)ISCLAIMER
-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.
L� // ll
'rint Name �-R y 1<" A Wei,,i ' Signature „IL/4)
,j
/lethod of Payment: (Faxed permit applications will only be accepted with major bankcard)
] Cash ❑ Check ❑ Mastercarb -VtSA ❑ Other
�V •
sankcard 41 - VIN#:
•
•
uthorized Signature: This document originally contained
Lunridential Liedit Lard InrUrrrratigrr which
was redacted pursuant to RCW 19.255.010
and the original document destroyed
pursuant to SOS DAN GS2014-030.