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2004, 03-25 Permit App: BLD-04-03901 Repair Fire Damage
Spokane .0.0Ualley 40. 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: S • �� 23 Assessor's Tax Parcel Number(s): Legal Description: PERMIT DESCRIPTION: © Building Permit ❑ Relocation ❑ Change in Use ❑ Grading ❑ Manufactured Home ❑ Tenant Improvement 11 Fire Safety ❑ Other OWNER/APPLICANT INFORMATION ❑ Owner: A\ -,c(. e G )( }e r Phone: Fax: ❑ Applicant: Phone: Address: S l-42.3 I cv-Glt5 h Address: S \ y'q City tate Zip Code Fax: City Contractor: Si 114 (0 G-ci ra % Co- , ❑ Architect: Phone: 9 2 6- 357-5" Fax: /2 8- y f y I Phone: Address: 15 32 E • A/16, 1-e t -i.1 S+ i I p. lc ceiL kAJ City WA State Contractor License #: � 1 M.M C e. Contact: 1 gi'-4-213—/ State Zip Code Address: State Zip Code Fax: City State Zip Code 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: 3 0 IL- , 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC SYSTEM?