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2004, 08-18 Permit App: BLD-04-07405 Change of Usen0ry ()F72 PO.Kane . ,Valley i BUIWING PERMIT APPLICATION WORKSHEET City of Spokane Valley Community Development Department . Building Division 19707 E. Sprague Avenue, Suite 106 Spokane Valley, LVA 99206 Phone: (509) 688=0036; Fax: (509) 688-0037 _ REQUIRED SITE INFORMATION • . Street Address: /3p 7 S Assessor's Tax Parcel Number(s): Legal Description: PERMIT DESCRIPTION: ❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home ❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other OWNERIAPPLICANT INFORMATION U Owner: �'®vr� ,� ,� �o 1, W" Phone: ZZF-a y,y Fax:. Address: ��,_ �-,/,ts { q/ Ci State Zip Code Contractor: Phone: Address Fax: City State Zip Code WA State Contractor License #: El Applicant: Phone: Fax: Address: City State Zip Code ❑ Architect: Phone: Fax: Address: City State Zip Code Contact: PERMIT/BUILMNG INFORM ATI HEIGHT TO PEAK DIMENSIONS: # OF STORIES: MAIN FLOOR TO SQ: FTG: FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: FINISHED BASEMENT SQ. FTG: GARAGE SQ: FTG: DECKtCOV. PATIO SQ. FTG: OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE: # OF BEDROOMS: 'PROJECT'.' TOTAL HABITABLE SPACE: IMPERVIOUS. SURFACE AREA: COST OF 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC SYSTEM? 1�v . nin I —' - _1, .. . - IN. Y 1 9 Cp` 4 O r; f v 3r' 1 i .i • 1� µ 17 ■ fF' r IMO JT � - _- a' --- Yom:.' _ _ -_ .1111111111111 .. _ - --- __ A _ I Mr' a,,., *1 ..., , m. ., _ ,„ _ ..... ... ....,. , e - 0, ,,.., T � © 0. - 11 s r .65 K �,. -.al ca J k - N Q