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2004, 04-22 Permit App: BLD-04-04165 Safety InspectSOU:me Valley 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: / • Ste tAJs, 19-J F 1.014sh. q90 7. Assessor's Tax Parcel Number(s): Legal Description: (p 0 (int Le)I c A ,kLeij.rz f) 1i__ Tr - PERMIT DESCRIPTION: 0 Building Permit ❑ Change in Use ❑ Grading ❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Manufactured Home 0 Other OWNER/APPLICANT INFORMATION ❑ Owner: l iillzi� �i 501-65. '' (ioi) ❑ Phone: SZ Fax: ,ri Address: /4,03 \7. ALS_ ViPfi i\t--I • W • a 7 City State Zip Code Applicant: Phone: Fax: Address: City State Zip Code 0 Contractor: ❑ Architect: Phone: Fax: Phone: Fax: Address: Address: City State Zip Code City State WA State Contractor License #: Contact: Zip Code PERMIT/BUILDING INFORMATION HEIGHT TO PEAK: DIMENSIONS: # OF STORIES: MAIN FLOOR TO SQ. FTG: 2`u 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% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC SYSTEM? 1/GAOW . -Df) itt" fr\---`--" • J-(6(1 teitiutt n s'f eag • r 1--kj( s �) —yec los) /,,a7,0PE,e vz b4 -y fotor-