2004, 08-12 Permit App: BLD-04-07363 Tear Off, Reroof =p�, PotaneA --b .
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building g Division
11707 E. Sprague Avenue, Suite 106
. .4000Valley -
• • Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
II REQUIRED SITE INFORMATION-.
11i+tATION
4 .
Street Address: 1/Lipli C. gr-d. 4`e ,
Assessor's Tax Parcel Number(s):
- Legal Description:
PERMIT DESCRIPTION: � Ott- Ceditv5 k_e_ rooF re - (4Q0F 64- 6914 IIStA
dpi
❑ Building Permit El Change in Use ❑ Grading
❑ Relocation ❑ Tenant Improvement. ❑ Manufactured Home
P � ❑ Fire Safety ❑ Other
11 OWNER/APPLICANT INFORMATION
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Owner: to l- 4-ivn iu-1 y A-( ❑ Applicant:
Phone: gfo3-t.313q Fax: • ' Phone: Fax:
Address: /Ho/ E . X 32( 4' • Address:
City o taitc u4 1 .. 9q?-0 (o
State Zip Code City State Zip Code
❑ Contractor: : Fri O- 't5 �`
Phone: �❑ Architect:
Fax: Phone: Fax:
Address: Address:
City State Zip Code City - State Zip Code
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WA State Contractor License#: Contact:
PERMIT/BUILDING INFORMATION .
11
HEIGHT TO PEAK DIMENSIONS: #OF STORIES:
MAIN FLOOR TO SQ. FTG: 2"'l 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: 4jf rl DtAo�71 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
SYSTEM?
•
f
MANUFACTURED HOME
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Width: Length: Year:' Pit Set: •
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Manufacturer: •
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•
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• • 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:
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WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner: Phone: Fax:
Address: •
City State Zip
Inspector: Phone: Fax:
•
Address:
City State . Zip
SPECIAL INSPECTIONS
0 BOLTING ❑ CONCRETE ❑ REINFORCEMENT D WELDING
Firm Name: Phone:. Fax:
•
Inspector(s): •
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: l) 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 permit inure to the property owner.
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Print Name Signature
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Method of Payment: (Faxed permit applications willl only be accepted with major bankcard).
❑ Cash 0 Check . 0 Mastercard . • 0 VISA 0 Other
Bankcard#: Expires:' VIN#:
Authorized Signature: .