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
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