2005, 08-12 Permit App: 05002913 Reroof BUILDING PERMIT APPLICATION WORKSHEET
Crr city of Spokane Valley Community Development Department
Spiikat - Building Division
US - 2--111707 E. Sprague Avenue, Suite 106
�� s Spokane Valley, WA 99206
Y &s-L ‘ty I, 1 Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: 4O / U L
q°1 6- tAil ti Al
y (� ,
Assessor's Tax Parcel Number(s): o�
Legal Description:PERMIT DESCRIPTION: /a�L•(i( O [b- -g'
Er-Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
Relocation ❑ Tenant Improvement ❑ Fire Safety 0 Other
OWNER/APPLICANT INFORMATION
[J Owner. DWI / L 0 ' A (1,111411- ❑ Applicant: •
Phone: ' .g 'To 0 Fax: 1- `Y Phone: Fax:
Ado ress: . : -r//,. 4, Address:
City/ State 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:
Spokane Valley Bus. Liscense#: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
MAIN FLOOR TO SQ. FTG: 2""FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG: GARAGE SQ.FTG: DECK/GOV. PATIO SQ. FIG:
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST 0_4 PPOJE//
C,TX O — 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
' SYSTEM?
MANUFACTURED HOME
Nidth: Length: Year Pit Set:
Manufacturer.
RELOCATION -
Previous Address: •
Proposed Use:
FIRE SAFETY
=ire Sprinkler. # of Heads: Fire Alarm: Paint Booth:
rent: Fireworks Display: Blasting: Date/Time:
Valuation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner. Phone: Fax:
address:
City State Zip
nspector. Phone: Fax:
kddress:
City State Zip
SPECIAL INSPECTIONS
BOLTING ❑ CONCRETE ❑ REINFORCEMENT ❑ WELDING
-irm Name: Phone: Fax:
nspector(s):
DISCLAIMER .
he permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
!welling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
)roperty owner. 3) The signatory is the property owner or has permission to represent the property owner in this
ransaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Zeferenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
'ermit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
)wnership of resulting development rights granted by any issued permit in re to the prope wn%er.r.�
'rint Name £ ILWL L "VMS Signature (WAIL' ��
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
] Cash ❑ Check 0 Mastercard 4 ) t24.ISA ❑ Other
>ankcard r,- -
authorized Signature: I L j Q 4 This document originally contained
corrfideirtial ereeik Bard-Minn which
was redacted pursuant to RCW 19.255.010
and the original document destroyed'
pursuant to SOS DAN G52014-030.