2004, 03-23 Permit App: BLD-04-03870 ReroofSp`mokane
#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: 5?- I I Cl clef spU`ccoV \kite(J ) Ra2lb
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: aGULr cioc- -n 1- \C LACK- IrU0f1nq
n Building Permit
❑ Relocation
❑ Change in Use ❑ Grading ❑ Manufactured Home
n Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
[-1
Owner: -1:Db ooack 1.--1160C- Z -C1 Se -a6 ❑
Phone: 62d- O 4p) Fax:
Address: 5d -I -t- N niers( .1er) Aff
yer Ya ll (t J I,(rl4 q(12 -16C ty State , Zip Code
Applicant:
Phone:
Address:
Fax:
City
On Contractor: Ma tram ty/A03V1oJ (LjylCfVl A. ❑ Architect:
Phone: 5'16) 'L40 Fax: mer) Phone:
Address: GLI -2--( ly.. L-vergvj2Cv7 r&'
S pt L.LYLQ ¥GLL l.Q,L4 U qq a l (o
Zip Code
City State
State Zip Code
Address:
Fax:
City
State
WA State Contractor License #: VC t-Wi ML'kContact: lb A . Meg
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2ND 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-
3 11 5' 0
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?