2004, 11-03 Permit App: BLD-04-08121 Tear Off, Reroof y BUILDING PERMIT APPLICATION WORKSHEET
* SQTY't 'kane - City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
4000,Vall Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: J U 51 ),
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
IR Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
n Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: C�, , 6Z-- ❑ Applicant: CV-
Phone: Fax: Phone cc 7) s ? 40a-7 Fax: ,,�_
Address: Address: ZS`o r A✓f f,:,.,,-mac
City State Zip Code CitS Q Z7
State Zip Code
❑ Contractor: ❑ Architect:
Phone: Fax: Phone: Fax:
Address: - Address:
City State Zip Code City State Zip Code
WA State Contractor License #: Con/ •-T/;' 0yy,a; Contact: 477,(;- 2/•-7-7--,,,i(-57
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; (Faxed permit applications will only be accepted with major bankcard)
❑ Cash 52,Check L] Mastercard ❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature: