2004, 09-03 Permit App: BLD-04-07560 Tear Off, Reroof .• dosolliS
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• : BUILDING PERMIT APPLICATION WORKSHEET
Sii6kane City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
e • Spokane Valley, WA 99206
• .Phone: (509) 688=0036•F.ax: 509 688-0037
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REQUIRED SITE INFORMATION.••
Street Add rens: I/z--/00 -tg- .36 ' . -
Assessor's Tax Parcel Number(s): • - .
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Legal Description: '. .
PERMIT DESCRIPTION: ',Len"( (YR 7or on.61 Noi , r Icic_c p ►tuaod fe 5n i',. Le .
❑ Building Permit ❑ Change in Use • ❑ Grading ❑ Manufactured Home
0 Relocation 0 Tenant Improvement ❑ Fire Safety 2 Other
OWNERIAPPLICANT INFORMATION
Owner: be L-1;e1,-\ �w c c_4-&t,,, EW Applicant: ,,,:rarryt
Phone: 'VII - i- Iol' Fax: Phone: Fax:
Address: wf ao C 36 - Address:
. SP3 i(ocly VA1 kA. GGA q9 ,to • .
City • State Zip Code City ,State Zip Code
Contractor:
C'orYy .• •0 Architect:
Phone: • Fax: Phone: Fax: -
Address: Address
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City State Zip Code • City. • State Zip Code
WA State Contractor License#: Contact:
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• PERMIT/BUILDING INFORMATION .
I-EIGHT TO PEAK • DIMENSIONS: #OF STORES:.
MAIN FLOOR TO SQ. FTG: 21.4J FLOOR SQ. FIG: 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: • 0 700
• 3O%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
SYSTEM?
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MANUFACTURED HOME 1
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Width.; • Length: Year:' Pit Set: • •
Manufacturer: .
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• • •• • RELOCATION • •
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. : Previous Address:
Proposed Use: •
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FIRE SAFETY •
Fire Sprinkler: # of Heads: Fire Alarm: Paint.Booth:
Tent: 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
• Inspector: Phone: Fax:
Address:
City State . Zip
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SPECIAL INSPECTIONS 1
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0 BOLTING 0 CONCRETE • D REINFORCEMENT 0 -WELDING
Firm Name: . . Phone:. Fax:
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Inspector(s): •
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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) AU 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 will only be accepted with major bankcard).
❑ Cash ❑ Check 0 Mastercard . ' 0 VISA • 0 Other
• Bankcard#: • Expires: • • •VIN#:
Authorized Signature: