2004, 05-13 Permit App: BLD-04-04342 ResideSpokane
Dalley
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: /ff/? E
Assessor's Tax Parcel Number(s): L�
Legal Description:
PERMIT DESCRIPTION:
Ct° `-e
Building Permit n Change in Use n Grading
n Relocation [1 Tenant Improvement n Fire Safety Other
Manufactured Home
OWNER/APPLICANT INFORMATION
Owner:
Phone: 9�/ _'- Fax:
Address: M7-7 t 4,4&,A-4
City
Contractor:
Phone:
State
Applicant:
Phone:
Address:
Fax:
Zip Code City
Address:
Fax:
City
State Zip Code
WA State Contractor License #:
State Zip Code
n Architect:
Phone: Fax:
Address:
City
Contact:
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:I -1
DIMENSIONS: —/' cam,
# OF STO f S:
MAIN FLOOR TO SQ. FTG:'
2"" FLOOR SQ. FTG: --,
UNFI BASEMENT SQ. FTG:
FINISHED BASEMENT SQ TG:
GARAGE SQ. FTG: —,DECK/COV.
PATIO SQ. FTG:
?:s;,
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE: se,....5
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
D���� -
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash
Bankcard #:
Authorized Signature:
ICheck
❑ Mastercard
❑ VISA
Expires:
VIN#:
❑ Other