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2004, 03-23 Permit App: BLD-04-03865 ReroofCITY Spokane Valley qG BUILDING PERMIT APPLICATION WORKSHEET City oftpokane 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: /`v o' 1/ut5Siov Assessor's Tax Parcel Number(s): Legal Description: PERMIT DESCRIPTION: (vac F 10Q ere( [Building Permit ❑ Change in Use n Grading ❑ Manufactured Home (—I Tenant Improvement LJ Fire Safety ❑ Relocation ❑ Other OWNER/APPLICANT INFORMATION Owner: Phone: Address: Fax: ❑ Applicant: Phone: Address: Fax: City State Zip Code City Contractor: %/NV L- V N i y JZ s P n G n Architect: Phone: -)%2--32s3 Fax: 4>7-s3» Phone: Fax: Address: Po G.K.- Address: State Zip Code erCyil7 rty State Zip Code City State Zip Code WA State Contractor License #: t2rvt_v, , of s KtZ Contact: UPI v Iva net 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: /19 PO 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 #: Authorized Signature: heck 0 Mastercard ❑ VISA Expires: VIN#: 0 Other