2004, 07-16 Permit App BLD-04-07089 Re-Roof.ros Valley
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
Street Address:
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
Dia Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation
❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: ii e. _ /i/// E Applicant:
Phone: ,27-os,27Fax: 929-19g Phone: Fax:
Address: 9,2/,2 / . c /v6 , v, Address:
i'kar
tY StateZip Code City State Zip Code
❑ Contractor. S //. • ❑ Architect:
Phone: Fax: Phone: Fax:
Address: Address:
City
State Zip Code
WA State Contractor License #:
City
State
Contact:
Zip Code
PERMIT/BUILDING _INFORMATION
HEIGHT TO PEAK
DIMENSIONS:
g/ — 020
# OF STORIES:-
MAIN FLOOR TO SQ. FTG:
2" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG;
GARAGE SQ. FTG:
DECK/COV. PATIO SGL,FTG:
f�2s —® 3co,1�
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT`WURCE:
# OF BEDROOMS
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COS PR03LCT: '
�—
30% SLOPES ON PROPERTY:
SEWER OR ON -SITE SEPTIC
SYSTEM? ,-)r.k
MANUFACTURED HOME
Width:
Length: Year: Pit Set:
Manufacturer:
• RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent:
Valuation: Above/Underground Storage Tank Size:
DateiTime:
Fireworks Display: Blasting: •
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner.
Address:
Phone: Fax:
City
Inspector: Phone: Fax:
Address:
City
State
State
Zip
Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
❑ REINFORCEMENT
Firm Name: Phone:.
❑ WELDING
Fax:
Inspector(s):
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that 4) 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 Wiley 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: