2004, 04-23 Permit App: BLD-04-04181 Tear Off, Reroof MAR 18 2884 11 43 FR TO 9249728 P.01/81
BUILDING PERMIT APPLICATION WORKSHEET
SCITY City of Spokane Valley Community Development Department
po ne , Building Division
11707 E. Sprague Avenue, Suite 106
401004Valley
Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: //-'Z, 1 Lo - //z/) -- -Se , /tz /e) ( J vd1 E),)
Assessor's Tax Parcel Number(s): y S ( Ce' 3 " CG 13 `j
Legal Description: O P P c3O f AJ D ..L S )4 L e' o L 2 i3 L
PERMIT DESCRIPTION: 4"Cr,A5 0 f 01 va f ± /-1.„L--t--c_ 1/ ,•-, ) kez.f cn-t e
El Permit L❑ Change in Use ❑ Grading 0 Manufactured Home
fl Relocation Ti Tenant Improvement ❑ Fire Safety 2 Other Re Ka-L-4-
-
OWNER/APPLICANT INFORMATION
Ti Owner: lAi. /-I i- 01-1.-7 <S I z; 0,j ❑ Applicant: -SC r►-\,e-
Phone: `72.1- 5'Yo 1- Fax: Phone: Fax:
Address: P.o. 6,x 170 I Address:
� i . e., -
Ctty State Zip Code City State Zip Code
Ti Contractor: El 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: I
MAIN FLOOR TO SQ. FTG: 2""FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
/ ---60
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
3c>b' f-t
OCCUPANCY GROUP: CONSTRUCT-140N TYPE: HEAT SOURCE:
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
•
COST OF PROJECT: 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
Csve — , SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature: ,
** TOTAL PAGE.01 :+::+:
03/18/04 THU 11:43 [TX/RX NO 5815]