2004, 10-12 Permit App: BLD-04-07899 GradingOCT 11 2004 12:28 FR
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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:tra• hDr�
Assessor's Tax Parcel Number(s):
Legal Description: 7 -25- Ai
PERMIT DESCRIPTION:
D Building Permit D Change in UseGrading ❑ Manufactured Home
111 Relocation
�L/9
c a
0 Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
a. Owner.
Phone:
>,egneri Aci
2`7-060Y Fax:
3Z %Ssiv r,
-4 "D3
State Zip Code
Applicant: // Y
Phone: r22&.- 033 ax; .226,
Address: lc) 2 1(1
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Stats Zip Code
Contractor. Architect:
l \
Phone: .226, 4)3.33 Fax: .2.26,./33L Phone: Fax:
Address; P,). 1 . t(1 • Address:
!J11- 970
City Stags Zip Code
City
WA State Contractor License #: E PC �"- V2c.3 Contact:
State
Zip Code
- $ 7f
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIONS:
# OF STORES:
MAIN FLOOR TO SQ. FTG:
2w FLOOR SQ. FTG: —
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ FTG:
GARAGE SQ. FTG:
' DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:.
# OF BEDROOMS:
CONSTRUCTION TYPE: r
TOTAL HABITABLE SPACE:
HEAT SOURCE:
IMPERVIOUS SURFACE ARE&
COST OF PROJECT;
30% SLOPES ON PROPERTY:
SEWER. OR ON-SITE SEPTIC
SYSTEM?
ethod of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash 0 Check 0 Mastercard 0 VISA
0 Other
Bankcard #:
Authorized Signature:
Expires:
** TOTAL PAGE.13 **