2004, 11-05 Permit App: BLD-04-08126 Reroofsii61'.
sonalley
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: ICIi £ 5 sapoK,Onie.
Assessor's Tax Parcel Number(s):
Legal Description: �p
PERMIT DESCRIPTION: - rcc-f - irt thi dud fftia4 ..
❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Owner: nIi
dwell.
Phone:
Fax:
Address:
L tca4
Ci State
❑ Applicant: iia
Phone:
Fax:
Address:
Zip Code City
❑ Contractor:
Phone:
Address:
Fax:
City
State Zip Code
State Zip Code
❑ Architect:
Phone: Fax:
Address:
City
State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIONS:
it OF STORIES:
MAIN FLOOR TO SQ. FTG:
2"" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECK/GOV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
5.- Y"r.ion
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Mastercard
❑ Cash 0 Check
0 VISA
Bankcard #: Expires: VIN#:
❑ Other
Authorized Signature: