2005, 02-11 Permit App: 05000436 Roof AdditionProject Number: 05000436 Inv: 1 Appligation Date: 02/11/2005 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Proiect Information:
Permit Use: ADD NEW ROOF DORMER & GABLE TO Contact: TOMBARI, JAMES & SHARI
EXISTING ROOF ON RESIDENCE Address: 10919 E 25TH AVE
C - S - Z: SPOKANE VALLEY, WA 99206
Setbacks: Front Left: Right: Rear: Phone: (509) 448-9262
Group Name:
Site Information • Project ame.
ask -
Plat Key: 001393 Name: KOKOMO TOWNSITE (FEES) District: Sout
Parcel Number: 45283.2712 Block: Lot:
SiteAddress: 10919 E 25TH AVE Owner: Name: TOMBARI, JAMES & SHARI
Address: 10919 E 25TH AVE
Location:: CSV SPOKANE VALLEY, WA 99206
Zoning: AGSUB
Water District: Hold: ❑
Area: .00 Acres Width: 90 Depth: 130 Right Of Way (ft): 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information: t%=,. ......,..
Revi
Plan
Permits:
Building Permit --
Contractor: OWNER Firm: OWNER
Phone: (000) 000-0000
This Application: Total Project:
Description Grp Type Notes Scl Ft Valuation Scl Ft Valuation
RESIDENCE R-3 VB ADD ROOF 0 $2,500.00 0 $2,500.00
DORMER
Totals: 0 $2,500.00
Item Description Units Unit Desc
RESIDENTIAL PERMIT FEE 1 SELECT
STATESURCHARGE 1 SELECT
RESIDENTIAL PLAN REVIEW 1 SELECT
Permit Total Fees
0 $2,500.00
Fee Amount
$83.25
$4.50
$33.30
$121.05
Operator: K C Printed By: K C Print Date: 02/11/2005
Project Number: 05000436 Inv: 1 Application Date: 02/11/2005 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes:
Payment Summary
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $121.05 $121.05 $0.00 $121.05
$121.05 $121.05 $0.00 $121.05
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: K C Printed By: K_C Print Date: 02/11/2005
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Street Address:
Assessor's Tax Parcel Number
Legal DescriptionI G .r
PERMIT DESCRIPTION:
BUILDING 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
Building Permit ❑ Change in Use ❑ Grading
Relocation ❑ Tenant Improvement ❑ Fire Safety
� L 0 N
❑ Manufactured Home
❑ Other
II OWNER/APPLICANT INFORMATION fl
❑ Owner: 2n *
DIMENSIONS:
❑ Applicant: q
S 20e
Phone:2 Z Fax:
UNFIN BASEMENT SQ. FTG:
Phone: p
ax: Z
Address:
OCCUPANCY GROUP:
Address:
HEAT SOURCE:
5
bio
IMPERVIOUS SURFACE AREA:
F PROJECT:
COS Op�
ity State
Zip Code
City
St to Zip Code
❑ Contractor:
❑ Architect:
Phone: Fax:
Phone:
Fax:
Address:
Address:
City State
Zip Code
City
State Zip Code
WA State Contractor License #:
Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO P� K
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2 u 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:
F PROJECT:
COS Op�
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME I
Width: Length: Year: Pit Set:
Manufacturer:
Previous Address:
Proposed Use: _
RELOCATION
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm:
Tent: Fireworks Display: Blasting:
Valuation: Above/Underground Storage Tank Size:
Paint Booth:
Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
Fax:
City State Zip
Inspector: Phone: ,Fax:
Address:
City
State Zip
I SPECIAL INSPECTIONS I
❑ BOLTING ❑ CONCRETE
Firm Name-
Inspector(s):
❑ REINFORCEMENT
Phone:
Fax:
❑ 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 permit inure to the property owner.
Print Name
Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard
Bankcard #:
Authorized Signature:
Expires:
❑ VISA ❑ Other
VIN#:
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