2005, 06-30 Permit App: 05002251 Roof Repair 0 —. 2z 1
BUILDING PERMIT APPLICATION WORKSHEET
CITY(W City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
40000Vall Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: yz7/7 & -4198 a .
Assessor's Tax Parcel Number(s):
Legal Description: '/4 H , ,
PERMIT DESCRIPTION: 6.74.4-1 2 VA'''4tra1D Us=- 1401./0 J Fart-/-4
[Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: ALO' j&-iii-EA--•
❑ Applicant:
Phone:Gr•gf,•o(38z- Fax: 9 477 7Zgr) Phone: Fax:
Address: /Z.-7,7 E TA44-a a A,0. Address:
.1,U1U e VAL.r esq h/il 1c72.4 .
City State Zip Code City State Zip Code
❑ Contractor: J21-I-- ❑ Architect:
Phone: Fax: Phone: Fax:
Address: - Address:
City State Zip Code City State Zip Code
WA State Contractor License #: Contact:
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%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
SYSTEM?
Method of Payment: (F d permit applications will only be accepted with major bankcard)
3-75
❑ Cash Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature: