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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#: