2004, 06-08 Permit App: BLD-04-04524 AdditionSpokane
.000/Ualley
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: /22/e E L a h 0 ✓Ct�
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
L Building Permit ❑ Change in Use ❑ Grading
❑ Relocation
❑ Manufactured Home
❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Owner / Q M 1-11 OSed
Phone:I/ ; -;-q1/ Fax:
--z3/ -5
Address: 2 q / vY S m 1! ke r
111
Applicant:
Phone:
Address:
Fax:
City
lState Zi Code r City State Zip Code
❑ Contractor: NQ r O` "l�G� �CO hS radf 10th ❑ Architect:
Phone: a r"Fa9� �S Phone: Fax:
Address: 0 IP#V Vl -e Address:
City State Zip Code City State Zip Code
WA State Contractor License #: WWo rd i G q 9 7 &Contact: TO Ph
11,10_.‘ 61-1-
PERMIT/BUILDING
-
PERMIT/BUILDING INFORMATION
HEIGHT OPEAK:
DIMSSIGN 7
# OF DRIES:
MAINFLOQR TO SQ. FTG:
2"" FLOOR O. FTG:
UNFIASEMENT SQ. FTG:
N,�
FINISHED BASEMENT SQ. FTG:
`-5'
GARAG SQ. FTG:
~ u
DECK/COV. PATIO SQ. FTG:
77
OCCJ4PANCY GROUP:
U< 3
CONSTI�UCTfQN TYPE:
Wood -h r 0 hie
AT SOyiRCE:
3 / &7'r � C.
# OF BEDROOMS:
Z
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
OST OF PROJECT:
1 D 00
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM? ..5:Q We r
,•••• : • f • ; • : "
Th filte plan is belfl9 submitted 101 ens purpose of
0.14:41A: .s.c41‘micling tir4D 3110.is a *us Sod correct
All apovort property
ko..b:tirit4;;,1ji555fl4S1flIfltS
t1.11.1.1 it : tr, • 1i lip tF jarik laarids.
04M to -;}.•.t10.:eit,ires.or other,oillisal arias.
. .
1„4.1.• •
. 4404-
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