2004, 05-28 Permit App: BLD-04-04468 Reroof BUILDING PERMIT APPLICATION WORKSHEET
SITY arm 10111"1\1111.%
pokaneCity of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
4,0004Valle37Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: 6 aa., a
4449_.
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: ad-u-8C
�uilding Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: Ubit2,4tOPAL) r i ❑ Applicant: y ,y,,t a gK,�t.,,c4}
Phone: g n74 yy Fa Phone: Fax:
Address: P 6 /�„t.rf $o 6 6 Address:
uf� v
City State Zip Code-, City State Zip Code
❑ Contractor: c rj yi , ) ❑ Architect:
Phone: q?-7 95yy Fax: Phone: Fax:
Address: ,v v S m66, Address:
wa g"q�o
City State Zip Code City State Zip Code
WA State Contractor License #: Contact: &.e (c+— rt, 612 7 95r1iv
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
MAIN FLOOR TO SQ. FTG: 2N''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?