2004, 09-13 Permit App: BLD-04-07631 Tear Off, ReroofBUILDING 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: It Cu -roJ
Assessor's Tax Parcel Number(s):
Legal Description:
PERMrc DESCRIPTION: gE 160/5P
0 Building Permit 0 Change in Use fl Grading 0 Manufactured Home
E Relocation F7 Tenant Improvement E Fire Safety n Other
OWNERIAPPLICANT INFORMATION
111 Owner: fry frz fl(\Yr
n Applicant:
Phone: qq5 - Zeit Fax: Phone: Fax:
Address:
Address:
City State Zip Code City State Zip Code
Contractor: riatiteD ci-SOW) L.c.c. 1-- Architect:
Phone:6) Aps -q5b1 Fax: falk Phone: Fax:
Address: 14. 4705 t.it4144rVALE. De. Address:
iFbelii. tkor 'gni('
City State Zip Code City State Zip Code
WA State Contractor License #: CSLq7-L7 Contact: .i61Y._ L. af-F11•1
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2 FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
• FINISHED BASEMENT SO FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACEAR :
COST OF PROJEC.
30% SLOPES ON. PROPERTY:
SEWER OR 0 E SEPT
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankc
Ej Mastercard
11] Cash
Bankcard #:
Check
Authorized Signature:
Expires:
VISA
d)
070-3?
Other
VIN#: