2004, 03-29 Permit App: BLD-04-03928 Reroof BUILDING PERMIT APPLICATION WORKSHEET
uTCity of Spokane Valley Community Development
ent Department
. ne Building Division
11707 E. Sprague Avenue Suite 106
40000i'all Spokane
Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: 5(D 3 C, 0-h
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:Rct..,r
VI—Building Permit I I Change in Use Grading I I Manufactured Home
n Relocation n Tenant Improvement Fire Safety Other
OWNER/APPLICANT INFORMATION
Owner: n Applicant:
Phone: Fax: Phone: Fax:
Address: Address:
City 0 State Zip Code City State Zip Code
Contractor: > v\i - an Architect:
Phone: 1-yS2- Fax: Phone: Fax:
Address: pc hkcnHot % Address:
L't.avu Wig qa5'
City State Zip Code City State Zip Code
WA State Contractor License #:1r9NKSS LO3`4Contact: DIAJ Ri I `y52l
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
MAIN FLOOR TO SQ. FTG: 2""FLOOR SQ. FTG: UNFIN BASEMENT SQ. FIG:
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:AA9 C) 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
k SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard#: ') Expires: VIN#:
Authorized Signature: U^-r- vl