2004, 05-04 Permit App: BLD-04-04252 Reroof*lane
Valley
BUILDING PERMIT APPLICATION WORKSHEET
Cityaf 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: "I iq Aj 460464
Assessor's Tax Parcel Number(s):
Legal Description: r
PERMIT DESCRIPTION: Pee
Building Permit
❑ Relocation
❑ Change in Use ❑ Grading
n Tenant Improvement ❑ Fire Safety
❑ Manufactured Home
n Other
OWNER/APPLICANT INFORMATION
❑ Owner: (94In gad
Phone:74 em Fax:
Address: lC
S9aKc,p� Rot
Stater ^`1 Zip Code
iWel OVA
Fax:
❑ Contractor:
Phone:
Ades
City I
State
2
Zip Code
Applicant:
Phone:
Address:
Fax:
City State Zip Code
n Architect:
Phone: Fax:
Address:
City
WA State Contractor License #:,U,Pesi p pQbL/- Contact:
State
Zip Code
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:Qp
0500.
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 #:
❑ Check
❑ Mastercard
Authorized Signature: •
0 VISA
Expires: VIN#:
❑ Other