2004, 06-29 Permit App: BLD-04-04759 Tear Off, ReroofSpokane
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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: 101(1 6 �10cttU 70 /HN2. o ora�i? UW �iola4�
Assessor's Tax Parcel Number(s): 1 -ISI 7) . I al%
Legal Description:
'Dk PERMIT DESCRIPTION: /)e mo✓e u i) P f Oof i we !fir ny
it Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Owner ssiu. V
Phone: 9a1 -198b Fax:
Address: 0 1 E f3A
ltao 3
\f t l QA -
C State
Contractor: eQ
Phone: Fax:
kre:
Address:
Y9)6G
Zip Code
City
State
WA State Contractor License #:
Zip Code
❑ Applicant: .Stem,t a o t1w'
Phone: Fax:
Address:
City State
❑ Architect: N I k
Phone:
Address:
Zip Code
Fax:
City
Contact:
State
Zip Code
" .PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIONS:
# OF STORIES:
MAIN 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:
COT F PROJ�CT:
ii 000-
30% SLOPES ON PROPERTY:
-
SEWER OR ON-SITE SEPTIC
,SYSTEM?