2004, 07-02 Permit App: BLD-04-07012 Tear Off, Reroof • 'BUILDING PERMIT APPLICATION WORKSHEET
*lane City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
400000V
ale► Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: 1 q°t f S-" _ " 6 /--( - 2 0/
Assessor's Tax Parcel Number(s):
Legal Description: `'
PERMIT DESCRIPTION: Q C - -E_cz - x-11
• Building Permit n Change in Use n Grading 7 Manufactured Home
n Relocation ❑ Tenant Improvement n Fire Safety n Other
OWNER/APPLICANT INFORMATION
n Owner: �c.,v— 6rkAd4. fl Applicant: SQ,;,,.;� as O i,.F
Phone:(�N0�, -cc-4 Fax: Phone: Fax:
Address: 1, . � ,_ ►i Address:
6, e4 h �.
City State Zip Code City State Zip Code
❑ Contractor: n Architect:
Phone: Fax: - Phone: Fax:
Address: - Address:
City State Zip Code City State Zip Code
WA State Contractor License#: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
MAIN FLOOR TO SQ. FTG: 2m-'FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FIG: GARAGE SQ. FTG: DECKICOV. 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
15-0C SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash heck ❑ Mastercard ❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature: