2004, 04-05 Permit App: BLD-04-03972 Tear Off, ReroofSpokane
Dalley
- City of Sp
BUILDING PERMIT APPLICATION WORKSHEET
ane 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:
1013 N
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
DT Building Permit I Change in Use
n Tenant Improvement
f l Relocation
Grading
Fire Safety
n Manufactured Home
Il
Other
OWNER/APPLICANT INFORMATION
n
Owner: 6 eo r Q
Phone: 92 w c)6 Fax:
Address: Lori
VC 1644 1
City State Zip Code City
Applicant:
Phone:
Address:
Fax:
State Zip Code
Contractor: A M PCM -61.1- YzA.A) n Architect:
Phone: '3 ze,SPiL Fax: Phone: Fax:
Address: J ZD2-
` Lc k 9 9G;et
City State Zip Code
Address:
City
State Zip Code
WA State Contractor License #: rc¢ ;, Dr.; Contact: Sitvri 3 7o -t, y1
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
10/
DIMENSIONS:
# OF STORIES:
MAW 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%
..S o oc.;
'c
SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard
Bankcard #:
Authorized Signature:
VISA
Expires:
VIN#:
❑ Other