2004, 10-22 Permit App: BLD-04-08008 & BLD-04-08009 Change of Usea4r- rvd/moil
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: 506 'Nt \..S2 SS i 1<
Assessor's Tax Parcel Number(s):
Legal Description:. (
PERMIT DESCRIPTION: CIU I )tin IC k `b Res,d&ct \ D kat -1
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Er Building Permit Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
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Owner: Lai l-� tDz9k
Phone: q -q o 9 Fax:
Address: jctto 8 1�1. 3ess�e (z.d-
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State clW
Zip Code
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Applicant:,
Phone:
Address:
Fax:
City
State Zip Code
❑ Contractor: ❑ Architect:
Phone: Fax: Phone: Fax:
Address: Address:
City
State Zip Code
WA State Contractor License #:
City
Contact:
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TQ.P_EAK _ _ _ _ _ __ __
DIMENSIONS
#_OEST_ORIES
MAIN FLOOR TO SQ. FTG:
2"" FLOOR SQ. FTG:
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:
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
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06/10/2003 Page: 10