2004, 11-12 Permit App: 04009063 Tear Off, ReroofS#6@ne
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Street Address:
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
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Building Division
11707 E. Sprague Avenue, Suite 106 6
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE I FORMATION
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
❑ Building Permit
❑ Relocation
❑ Owner:
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❑ Change in Use ❑ Grading ❑- Manufactured Home
❑ Tenant Improvement ❑ Fire Safety Other may,/
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F1 Contractor: ElArchitect
Phone: In Fax: - Phone:
Address: Address:
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WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:W
DIMENSIIOONNS:
D
# OF STORIES:
X
MAIN FLOOR 70 SQ. G: /dB
2 FLOOR SQ. FTG: O
UNFIN BASEMENT SQ. FTG /�
FINISHED BASEMENT SQ. FTP:
GARAGE SQ. FTG: O
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DECKICOV. PATIO SO. FTG/�
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OCCUPANCY GROUP
CONSTRUCTION TYPE e
HEAT SOURCE��`_C
#OF BEDROOMS: /.
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA
COST OF PROJECT:
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30% SLOPES ON PROPER
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SEWER OR ON E SETIC
0
Method of Payment. (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #:
Authorized Signature:
Expires:
VIN#: