2004, 03-23 Permit App: BLD-04-03866 Reroofun or
Spokane
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:
30i
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
Et -Building Permit
❑ Relocation
k OL v\t,
❑ Change in Use E Grading ❑ Manufactured Home
❑ Tenant Improvement ❑ Fire Safety Other
OWNER/APPLICANT INFORMATION
Owner:
Phone:
Address:
Fax:
City
State
❑ Applicant:
Phone:
Address:
Fax:
Zip Code City
State Zip Code
Contractor: )til u I vA r y r'Lo b .t n o' ❑ Architect:
Phone: 4%t -;S3-3 Fax: 6,1?-s3?S Phone: Fax:
Address: po &b' 61wr Address:
Seotw.,E (ASA, C2( 1--,7
City State Zip Code
City
State Zip Code
WA State Contractor License #: Mutvq.> fltsgci2 Contact: J ;.M mo Iu o.4Q7
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:,30%
, 5p -o
SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash
Bankcard #:
Authorized Signature:
eck
0 Mastercard
0 VISA
Expires:
VIN#:
❑ Other