2004, 09-22 Permit App: BLD-04-07723 ReroofSpokjne
Ualley
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:
/e/ /e>=7
Assessor's Tax Parcel Number(s): SI Sof • 2 b`i
Legal Description:
� A BiRKE r i3/ 3D L4 8a
PERMIT DESCRIPTION: %°ems' elf re- to-o"F
E. Building Permit
❑ Relocation
Il
Change in Use ❑ Grading
❑ Tenant Improvement ❑ Fire Safety
Manufactured Home
C Other
OWNER/APPLICANT INFORMATION
[r Owner: t'/i4 /A)
Phone:y =/C/) Fax: 8.3 7/
Address: 7.6W ith /Yle/b'2 //? 14'
City State Zip Code
Contractor:
Phone:
jC�iC 'f'
Address:
Fax:
City
State Zip Code
WA State Contractor License #:
Applicant:
Sac -
Phone: Fax:
Address:
City
n Architect:
Phone: Fax:
State Zip Code
Address:
City
Contact
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2"`' FLOOR SO. 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:
497i /Z)0
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check
Bankcard #:
C] Mastercard
Authorized Signature:
❑ VISA
❑ Other
Expires: VIN#:
0 7 x 3 -- 4`13. 5