2005, 05-09 Permit App: 05001462 Re-RoofBUILDING PERMIT APPLICATION WORKSHEET
crl�' City of Spokane Valley Community Development Department
6T�.� Building Division
qp�11707 E. Sprague Avenue, Suite 106
I I Valley Spokane Valley, WA 99206
4.00 Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: /`/C/ /, 2 i -� / sL /d,, ti
Assessor's Tax Parcel Number(s):
Legal Description:
,PERMIT DESCRIPTION: /i,ig zii' �.yr_ Siy r4 s f�f -, �',= �.Q/<r�f Cwt, /'oyirF J �c'���K4
0— Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Owner:'
Phone: S�W- Y 2 i t/ Fax:
Address: 1,1y12- C. -;21 5'' 1-lvt
City State Zip Code
❑ Contractor:
Phone:
Address
city
Fax:
State Zip Code
WA State Contractor License #:
Spokane Valley Bus. Liscense #:
-4!
Applicant:
# OF STORIES:
Phone:
2 Nu FLOOR SQ. FTG:
Address:
FINISHED BASEMENT SQ. FTG:
city
❑
Architect:
CONSTRUCTION TYPE:
Phone:
# OF BEDROOMS:
Address:
S 4 wS C'�vrt4A
Fax:
State Zip Code
Fax:
City State Zip Code
Contact:
Contact:
PERMITIBUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2 Nu 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: -L
/ r�� L
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
Width: Length:
Manufacturer:
Previous Address:
Proposed Use: _
Fire Sprinkler:
Tent:
Valuation:
MANUFACTURED HOME
Ye9r:
RELOCATION
FIRE SAFETY
# of Heads: Fire Alarm:
Fireworks Display: Blasting:
Above/Underground Storage Tank Size:
Pit Set:
Paint Booth:
Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Inspector:
Address:
❑ BOLTING
Firm Name:
Inspector(s):
Phone: Fax:
city State
Phone: Fax:
city
SPECIAL INSPECTIONS
❑ CONCRETE ❑ REINFORCEMENT
Phone:
State
Fax:
Zip
Zip
❑ WELDING
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 pner.
Print NamecSignature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard
Bankcard #:
Authorized Signature:
Expires:
❑ VISA ❑ Other
VIN#: