2004, 03-23 Permit App: BLD-04-03869 ReroofSpokane
Dalley,
' 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: 11 1 o s 1 e_ r -N
Assessor's Tax Parcel Number(s):
Legal Description: G" `"c ' - '
PERMIT DESCRIPTION: `✓ ,,-aa 0--)p Izk
Building Permit
n Relocation
Change in Use
n Tenant Improvement
Grading 1 1 Manufactured Home
Fire Safety (1 Other
OWNER/APPLICANT INFORMATION
Fl
Owner:
Phone:
Address:
Fax:
City
State
Fl
Applicant:
Phone:
Address:
Fax:
Zip Code City
State Zip Code
�. Contractor: ht u t J& t yy f'�,,e„;�� fl Architect:
Phone: s3 F'ax: yap-S3?s Phone: Fax:
Address: Pc Go c:; a Address:
City
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.�.> 2-\7
State Zip Code
City
State Zip Code
WA State Contractor License #: Moly/42 z ,;r Kia Contact: �� rvr�i✓cRny
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 PROJECT:.
, 9J o .�
30% SLOPES ON. PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash
Bankcard #:
Authorized Signature:
Check
El Mastercard
❑ VISA
Expires:
VIN#:
❑ Other