2004, 12-01 Permit App: 04009226 Addition, Tear Off, Reroof CITI ilk - - BUILDING PERMIT APPLICATION
WORKSHEET
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Skane City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
40,17alley' Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
I1, REQUIRED SITE INFORMATION il
Street Address: 10 0 ;; ,- ; ; --I't-
�� Assessor's Tax Parcel Number(s): q`j a I , _cin (4)
Legal Description:
PERMIT DESCRIPTION: `- r1/2 (a„t4_ -, 0 ,vic p a! [/ &i-
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❑ Building Permit ❑ Change in Use
❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
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ii OWNER/APPLICANT INFORMATION �(
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❑ Owner: ' 6 rti j fn G. I
Phone: <1 3 (e/go FaxOa'I ❑ cant:
: Phone:hoFax:
r Address: 30)(0 S. --Pre- c Address:
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CityState Zip Code..) City State Zip Code
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❑ Contractor: CAuh
Phone: n Architect:
Fax: Phone: Fax:
Address: Address:
j City State
Zip Code City State Zip Code
WA State Contractor License#: Contact:
II PERMIT/BUILDING INFORMATION
1
HEIGHT TO PEAK DIMENSIONS:
0-0 ���� '`'�� #OF STORIES:
MAIN FLOOR TO SQ. FTG: 214FTG:"FLOOR SQ. t
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:
OST OF PROJECT: , 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
1.6,000 dLeAti PIO SYSTEM?
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Method of Pa me : '(FaxdC'� applications ermrt a
P pp ns will only be accepted with major bankcard)
❑ Cash ❑ Check 0 Mastercard
0 VISA 0 Other
Bankcard#: Expires: VIN#:
Authorized Signature: