2005, 06-29 Permit App: 05002234 Change of UseSji6lfane:
Valley
BUILDING PERMIT APPLICATION WORKSHEET
• City of Spokane Valley Community Development Department
r 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: f l 22. • 3 ou 810 Ace siZ c -
Assessor's Tax Parcel Number(s):
Legal Description: - /,'
PERMIT DESCRIPTION: CCcinc) e I --C ecow (4) s Ao(08E .1
❑ Building Permit
❑ Relocation
❑. Change in Use ❑ Grading ❑ Manufactured Home
❑ Tenant Improvement ❑ Fire Safety 9 Other
OWNER/APPLICANT INFORMATION
Kr-
Owner CZ -Oe )--(co-4112
Phone: Fax:
Address: 1322 s. Olc,ke
spokare_ vo (et( ki 9'1 Mt,
Applicant: fray/AAA-, (Iefineri1-e
Phone:6tPt) 30F241ot- Fax:
Address: 4(Z1 ill Co\coca g -c
6 fokcu.z vo..ti e 1 w A. 94/16
City State ' Zip Code City State Zip Code
❑ Contractor: 9 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/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
SYSTEM?
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