2004, 05-04 Permit App: BLD-04-04251 ReroofSpokane
Va11ey
BUILDING PERMIT APPLICATION WORKSHEET
City -of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
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Street Address: ) () 9a -! Ut1rtK
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: 7;ctl' 0 lbp�'
II
Building Permit
❑ Relocation
❑ Change in Use ❑ Grading
❑ Tenant Improvement ❑ Fire Safety
❑ Manufactured Home
n Other
OWNER/APPLICANT INFORMATION
❑ Owner: Jay
Phone: a •QAgy Fax:
Address: Sc•- .
City
(� Contractor: OU,
Phone: 99q 679
Address:
City
State Zip Code
Applicant:
Phone:
Address:
Fax:
City
State Zip Code
?fof:: r ❑ Architect:
Fax: Phone: Fax:
n•
State
Zip Code
Address:
City
WA State Contractor License #:/U!'C(rrf 4 Contact:
State
Atm. Qcfrelet,k
Zip Code
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:) O co
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
11 Cash
Bankcard #:
❑ Check
❑ Mastercard
Authorized Signature:
❑ VISA
Expires:
VIN#:
❑ Other