2005, 04-04 Permit App: 05001061 Tear Off, ReroofBUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: 13,�3 /2 C /D 7�1
Assessors Tax Parcel Number(s):
Legal Description:
D CRIPTION:
DIMENSIONS:
#OF STORIES:
MAIN FLOOR TO SQ. FTG:: -
:2 _FLOOR SQ_ FTG:
-UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
7PERMIT
Building Permit
❑
Change in Use ❑ Grading
❑ Manufactured Home
❑ Relocation
❑
Tenant Improvement ❑ Fire Safety
❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: EUc z_L 6 U7L
Phone: $� t� Fax:
Address:i� 4:161-Nvin �L iqg'
State tipCode
❑ Contractor:
Phone: !� Fax:
Address: sg� �J•,(>i�
City State Zip Code
WA State Contractor License *
❑ Applicant:
Phone: _
Address:
city State Zip Code
❑ Architect:
Phone: Fax
Address:
City State Zip Code
Contact:
PERMIT/BUILDING 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:
DEMCOV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJ CPL
V6 2J �__
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 ❑ 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 or. nances.
Ownership of resulting development rights granted by any issued permit inure to the prope y o, ner.
•
Print Name-1-1.5&=P/71 /--/67/?Sc y j Signature .___
Method of Payment: (Faxed permit ac tions will only be accepte. , : , ajor bankcard)
❑ Cash ' • 0 Check e ❑ Mastercard SAOther
Bankcard #: ._ Expires: VIN#:
f This document originally contained
Authorized Sign - confidential credit card information which
and the original document destroyed
pursuant to SOS DAN GS2014-030.