2004, 08-11 Permit App: BLD-04-07353 ReroofSlane
Valley
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: it 7 2? N
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
®Building Permit
❑ Relocation
1z L
Pd.4
❑ Change in Use ❑ Grading
❑ Tenant Improvement ❑ Fire Safety
❑ Manufactured Home
❑ Other
OWNER/APPLICANT INFORMATION
Owner:
Phone:
Address:
I/.v kuaw.✓
Fax:
City
Contractor:
Phone:
State
❑ Applicant:
Phone:
Address:
Fax:
Zip Code City
Address:
Fax:
City
State Zip Code
State Zip Code
❑ Architect:
Phone: Fax:
Address:
City
State Zip Code
WA State Contractor License #:b F17f C / i fG v Contact: M; /1t_ Pe Fez yr r
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:
1,;) DO
30% SLOPES ON PROPERTY:
t •
SEWER OR ON-SITE SEPTIC
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash +moi' Check ❑ Mastercard
Bankcard #:
Authorized Signature:
0 VISA
Expires:
VIN#:
❑
Other