2004, 06-23 Permit App: BLD-04-04697 Tear Off, Reroof*lane
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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: 36 / (p f3 5; (LK
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
❑ Building Permit
❑ Relocation
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❑ Change in Use ❑ Grading ❑ Manufactured Home
9 Tenant Improvement ❑ Fire Safety 9 Other
OWNER/APPLICANT INFORMATION
Owner Anne (11et- r; r lL
Phone: Fax:
Address: -.2)616) N , Nei(
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City V State
9
Applicant:
Phone:
Address:
Fax:
Zip Code City
® Contractor: Me r coir (0h s -/rt 4/6v1
Phone:(,cjij gg7-6P106Fax:
Address: gH/L 0 Hver &i
Spokai-,v uQc012
City I State Zip Code
❑ Architect:
Phone:
Address:
State Zip Code
Fax:
City
WA State Contractor License #: PWRCe G'9951JFContact: , )0A,
State Zip Code
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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:
COST OF P OJECT: y-
r % R -
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?