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2004, 06-25 Permit App BLD-04-04718 Re-Roof
jUalley BUILDING PERMIT APPLICATION WORKSHEET City of Spokane Valley Community Development Department Building Division 11707E Sprague Avenue, Suite 106 Spokane Valley, WA 99206 Phone; (509) 688-0036; Fax: (509) 688-0037 REQUIRED SITE INFORMATION 11 kStreet Address: - 7 7e� -5- v G L Assessor's Tax Parcel Number(s): *2_0,6 3, 4,Z o Legal Description: PERMIT DESCRIPTION: 6� Roo ITB�S� - /tern©ve RooF a -/P ✓�o©t 119 R/i�2 ❑ Manufactured Home ❑ Other 11 OWNER/APPLIGANT INFORMATION 11 El/ Owner: OgRR C n% � Se7T%ri/ tt" Phone: ?-:?6 Fax: _ Address: Cv � L id S C� H nJ e V1411 e V W,6 . 9a 2, City State Zip Code 2' Contractor: A✓ Qe%R rn , n/e_d Y e 7 - Phone: Phone: Fax: Address: City State Zip Code WA State Contractor License #: ❑ Applicant: Phone: Address: Fax: City State Zip Code ❑ Architect: Phone: Fax: Address: City State Zip Code Contact: PERMIT/BUILDING INFORMATION HEIGHT TO PEAK: [Building Permit ❑ Change in Use ❑ Grading FINISHED BASEMENT SQ. FTG: R. Relocation ❑ Tenant Improvement ❑ Fire Safety 119 R/i�2 ❑ Manufactured Home ❑ Other 11 OWNER/APPLIGANT INFORMATION 11 El/ Owner: OgRR C n% � Se7T%ri/ tt" Phone: ?-:?6 Fax: _ Address: Cv � L id S C� H nJ e V1411 e V W,6 . 9a 2, City State Zip Code 2' Contractor: A✓ Qe%R rn , n/e_d Y e 7 - Phone: Phone: Fax: Address: City State Zip Code WA State Contractor License #: ❑ Applicant: Phone: Address: Fax: City State Zip Code ❑ Architect: Phone: Fax: Address: City State Zip Code Contact: PERMIT/BUILDING INFORMATION HEIGHT TO PEAK: DIMENSIONS: # OF STORIES: MAIN FLOOR TO SQ. FTG: 2N"' FLOOR SQ. FTG UNFIN BASEMENT SQ. FTG: FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECKlCOV. PATIO SQ. FTG OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE: # OF BEDROOMS: TOTAL HABITABLE. SPACE: IMPERVIOUS SURFACE AREA: COST OF ROJECT: 30% SLOPES ON PROPERTY. SEWER OR ON-SITE SEPTIC SYSTEM? 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: WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE Plans Examiner: Phone: Fax: Address: City State Zip Inspector: Phone: Fax: - Address: City State Zip SPECIAL INSPECTIONS CI 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 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: