2004, 04-22 Permit App: BLD-04-04173 Tear Off, ReroofSpokane
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:
CHCl2
L c
Assessor's Tax Parcel Number(s): .
Legal Description:
PERMIT DESCRIPTION: ,en- /. Doi'
R -Building Permit ❑ Change in Use ❑ Grading
[1 Relocation ❑ Tenant Improvement ❑ Fire Safety
❑ Manufactured Home
❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: L24,/:a w (hiCis) 3ccic
Phone: T2y_s-,1-6 Fax:
Address: s. 2)o'7 <Ng,e -c cr
Vile #4✓)7 WA. 9903%
City State Zip Code City
❑ Contractor: s,t-iC A -s A-so✓rr ❑ Architect:
Phone: Fax: Phone: Fax:
❑ Applicant:
Phone:
Address:
Fax:
State Zip Code
Address: Address:
City
WA State Contractor License #:
State
Zip Code
City -
Contact:
State
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
r'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: /5_00
30% SLOPES ON PROPERTY:
SYSTEM?SEWER OR ON-SITE SEPTIC