2004, 04-06 Permit App: BLD-04-03980 Remodel Rpr 05 04 07: 20a Windows America 208 762-7803 p. 2
MAR 31 2004 15:16 FR TO 12087627803 P.01/06
.1� - ' BUILDING PERMIT APPLICATION WORKSHEET
CITY 0°. \rift Spokane City of Spokane Valley Community Development Department
cicg0 Building Division
11707 E Sprague Avenue, Suite 106
40,�le 61./1 / 2 Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509) 688-0037
L..... ..________.
REQUIRED SITE INFORMATION
Street Address; M/15 E, Sri r 'i%f? 4c e> 4d/
Assessor's Tax Parcel Number(s):
Legal Description: �,_�n r
PERMIT DESCRIPTION: tt 6 W( m0—, & �s� '4 ` 6
cAct(
seBuilding Permit ❑ Change In Use ❑ Grading ❑ Manufactured Home
Relocation ❑ Tenant Improvement 0 Fire Safety ❑ Other
w.
OWNER/APPLICANT INFORMATION
W612VA
[� Owner.CJ a� ��n� tAPPiicant: W I�
Phone:54 q k73/1 h Fax: Phone: Fax:
A dress: Oa , [J..: Address:
c /T �VrState e ' zip code Cir
State zip Code
VI Contractor: 1/4111a.Oi•6' 0 Architect: •
Phone:Ace q428343Fax: A..... ta- 3 Phone: Fax:
Add_rpss: t5.18 . ,•1• oAddress:
/� D ir3�13S.
City stay Zip Cods City' Stale Zip Code
WA State Contractor License*kV 11' "`17014 Contact: �& yriv
r
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: ' DIMENSIONS: #OF STORIES:
MAIN FLOOR TO SQ.FTG: 2'w FLOOR SO.FTG: 'UNFIN BASEMENT SQ.FTG:
FINISHED BASEMENT SQ.FIG: GARAGE SQ.FTG: DECKICOV.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? 1
Method of Payment: (Faxed permit applications will only be accepted with major bankcard) .,
❑ Cash ❑ Check ❑ Mastercard ❑ VISA 0 Other
Bankcard*; Expires: VINIC
Authorized Signature:
APR 05 2004 08 24 208 762 7803 PAGE.02