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