2004, 05-20 Permit App: BLD-04-04403 Remodel(1(103
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
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Street Address: 2 ,u /41144.7
L.�. /4cre6
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Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: -i 5L1
Building Permit
9 Relocation
D W 1/l S'1-,1 l 12 5 ) X34- Y o ,a Ail j
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9 Change in Use 9 Grading ❑ Manufactured Home
❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: n 4141.1,, 4, /ea wl �
Phone: 521-762 Fax:
Address: j1..r �s 4/soye
City
State Zip Code
Contractor: d to h e_ r('
Phone: Fax:
Address:
City State Zip Code
WA State Contractor License #:
❑ Applicant:
Phone:
Address:
Fax:
City
State Zip Code
❑ Architect:
Phone: Fax:
Address:
City State Zip Code
Contact:
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:
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?