2004, 11-17 Permit App: 04009091 ReroofBUILDING PERMIT APPLICATION WORKSHEET
Po
SLiTYtI�tone nst City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
000 01*
q 1 Spokane Valley, WA 99206
ValleY
I
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: S, 0/ C� 01j/Aif7"CJn b 99�
Assessor's Tax Parcel Number(s):
if -4{5 a -o3 /(-(o
Legal Description: /AJ
PE MIT DESCRIPTION:
43.W1Z. uilding Permit
n Relocation
❑ Change in Use (l Grading
Tenant Improvement ❑ Fire Safety 1 1 Other
Manufactured Home
OWNER/APPLICANT INFORMATION
Owner: jU C> (/lU 05111 011150.-)
yn
Phone: 701 -s Fax: 9 �4 - 777 5
Address: f %� • epic, / -f -0 3Cp
,01(AM L/,48cam w'A , 79c 1/
ate Zip Code
City
Contractor: T ieL 1.)/ eCOF--,n
Phone: ;'(/-10795 Fax:
Address: 5, g/O
City
Applicant: bit) Dif -0%11 0
Phone: OW- 03 q/ Fax:
Address: 44,2-2___& .S, /JG/u-26/"L
City 1 State Zip Code
Architect:
Phone: Fax:
Address:
State Zip Code City
WA State Contractor License #: N rG e flq .contact: A -rt -#A I -J
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
21°' ' FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECKICOV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECR.30%
11.P-0°
SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash '51 Check ❑ Mastercard ❑ VISA
Expires:
Bankcard #:
Authorized Signature:
VIN#:
❑ Other