2004, 04-05 Permit App: BLD-04-03966 Tear Off, Reroof*lane
Spokane
..N Valley
Street Address:
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 VL/r a'U1.1
ogiG E 1441/)
Assessor's Tax Parcel Number(s):
Legal Description: ^�
PERMIT DESCRIPTION: Re COOP a +eafc t
II
Building Permit
❑ Relocation
❑ Change in Use Grading ❑ Manufactured Home
n Tenant Improvement ❑ Fire Safety
in Other
OWNER/APPLICANT INFORMATION
n Owner:
Phone: 0,9,k- Oo/L2. Fax:
Address: same
ci
tic-41PY
State(
❑ Contractor: W, Pcr/enbu
Phone: y4y-19745 Fax:
Address: C,t9 -5hv
oirtvic te
Ci State
ciI Cre, (
Applicant:
Phone:
Address:
Fax:
n1`
Ztp Code City
J�veti-RAci Architect:
53H % NW . 9 - Phone: Fax:
Address:
94'202
State Zip Code
WA State Contractor License #:
Zip Code
City State
I fie r«rr9#OLL Contact:
IUtillnr�ix 97/en0
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/GOV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT' G
�taOC9U, en
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 #:
0 Check
❑ Mastercard
Authorized Signature:
4‘./ISA
Expires:
VIN#:
0 Other