2004, 04-01 Permit App: BLD-04-03957 Reroof BUILDING PERMIT APPLICATION WORKSHEET
I-1pcCM City of Spokane Valley Community Development Department
olribane 4 � Building Division
V .11 11707 E. Sprague Avenue, Suite 106
4.00Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: --,,C 5 - C.nil c.)s C
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: — 4r J<-fir \••-•D �(Q,115j�tr�
7
FI Building Permit n Change in Use I J Grading Manufactured Home
n Relocation Tenant Improvement I I Fire Safety n Other
OWNER/APPLICANT INFORMATION
n Owner: ?IsA ,\fi� I Applicant:
� PP
Phone: Fax: Phone: Fax:
Address: Address:
City tate Zip Code City State Zip Code
❑ Contractor: \\-.N62 \tre_S-rr\J ❑ Architect:
Phone: Fax: Phone: Fax:
Address: \V .2:0 e . irl-tel,► Address:
Cityb um W IA_ �7Z
State Zip Code City State Zip Code
WA State Contractor License #: ! Im 1C3 UL/Contact: ��mk�`L
4/40/as
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: J 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
/ /9(/ SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard#: ; 77 'xpires: VIN#:
Authorized Signature: !'