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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#: