2004, 05-07 Permit App: BLD-04-04286 Reroof`'e 4
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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
Street Address: L\OZt 5• L3°6\✓1�f-
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
'uilding Permit
❑ Relocation
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❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Tenant Improvement ❑ Fire Safety . ❑ Other
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OWNER/APPLICANT INFORMATION
❑
Owner ye ?t,\,rriSL.
Phone: til- PlOo`3 Fax:
Address: i10Z S. iaoo&,r—$
Applicant:
Phone:
Address:
Fax:
City . • State Zip Code City
❑ Contractor: S3(27 -`C cl-t,DV..r.. ❑ Architect:
Phone: °21/2.-334 Fax: n-3 oY$ Phone: Fax:
Address: c"1-.)G»t IV\tL) . Address:
c4vkc. -e . U ZIt1/4
Cif? State Zip Code City
State Zip Code
WA State Contractor License #:\)tiAYR.Lei52-053 Contact: k.j \r
State
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIONS:
# OF STORIES:
MAN 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 PROJEC : ' j - 'co
3O% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
0
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