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2004, 08-03 Permit App: BLD-04-07218 Tear Off, ReroofSCITY of P1,0kane oval ley y 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 HEIGHT TO PEAK: REQUIRED SITE INFORMATION- Street Address: Assessor's Tax Parcel Number(s): Legal Description: - PERMIT DESCRIPTION: ❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home ❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other DECKlGOV. PATIO SQ. FTG: OWNER/APPLICANT INFORMATI©N Owner: o- n ❑ Applicant: Phone: F x: Phone: Fax: Address: '11t)6_3 Address: City a Zip Code City State 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 PEAK: DIMENSIONS: # OF STORIES: MAIN FLOOR TO SQ. FTG: Z FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECKlGOV. PATIO SQ. FTG: OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE: # OF BEDROOMS: TOTAL. HABITABLE SPACE: IMPERVIOUS. SURFACE AREA: COST OF PROJECT:' 30% SLOPES ON PROPERTY. SEWER OR OPV -SITE SEPTIC SYSTEM? Width: Manufacturer: Previous Address: Proposed Use: Length: MANUFACTURED HOME Year: Pit Set: RELOCATION FIRE SAFETY Fire Sprinkler: # of Heads: Fire Alarm: Tent: Fireworks Display:, Blasting: Valuation: Above/Underground Storage Tank Size: Paint.Booth:. Date/Time: I WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE I Plans Examiner: Address: Inspector: Address: Phone: ' Fax: City State Phone: Fax: city I . SPECIAL INSPECTIONS State Zip Zip ❑ BOLTING ❑ CONCRETE ❑ REINFORCEMENT ❑ -WELDING Firm Name: I nspector(s): IU.'TTiTM Fax: 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) AGI 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 ❑ VISA ❑ Other Bankcard #: Expires: VIN#: Authorized Signature: