2004, 03-23 Permit App: BLD-04-03867 ReroofUTIOF :'
Spokane
var 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:
(0 Qt( IAA ls&rain
3D0
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: F -k - i Qo e tt'
[]Building Permit Ll Change in Use LJ Grading L Manufactured Home
❑ Relocation [] Tenant Improvement ❑ Fire Safety
❑ Other
OWNER/APPLICANT INFORMATION
Owner:
Phone:
Address:
Fax:
City
State Zip Code
❑ Applicant:
Phone:
Address:
Fax:
City
Contractor: rn o LV'F M te- oFtf t; (1 Architect:
Phone: tieL-3SS3 Fax: `tan-S?5 Phone:
Address: -Po R.,x iolBi Address:
ity n c. \ r w .
Ci State Zip Code
State Zip Code
Fax:
City
WA State Contractor License #: mur_vA�-ooswiz Contact:
r
State Zip Code
VIAQUe area)
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:
/jr(r0
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash eCheck 0 Mastercard 0 VISA
Bankcard #:
Authorized Signature:
Expires:
VIN#:
0 Other