2005, 03-30 Permit App: 05001024 Reroof s_ /d - 4(
BUILDING PERMIT APPLICATION WORKSHEET
*laneCity of Spokane Valley Community Development Department
ne Building Division
11707 E. Sprague Avenue, Suite 106
400,Vallev Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
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REQUIRED SITE INFORMATION
Street Address: /3g1/ , 2 y f
Assessor's Tax Parcel Number(s):
Legal.Description:
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PERMIT DESCRIPTION: a----,,eco—/w'
Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
0 Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
1! Owner: L X 4/. , /7a ❑ Applicant: ,,,,b�-
Phone: yv-vim Fax: Phone: Fax:
Address: - Address:
Gd,
State Zip Code (' City State Zip Code
❑ Contractor: C _ - Architect:
Phone:.; ; y Fa Phone: Fax:
Address: 2 r E Address:
City State Zip Code City State Zip Code
WA State Contractor License #: Contact
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
MAIN FLOOR.TO SQ.FTG; :. •.2"1-'FLOOR SQ. FTG: -:UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FIG: DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
CQS/7 OF OJJCT: 30% SLOPES ON PROPERTY: SYSTE OR ON-SITE SEPTIC.
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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:
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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
❑ 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 ordinances.
Ownership of resulting development rights granted by any issued per it inure the property owner.
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Print Name 1- re= G/. Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash 0 Check 0 Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature: