2004, 04-16 Permit App: BLD-04-04088 Reroof BUILDING PERMIT APPLICATION WORKSHEET
SCITY - City of Spokane Valley Community Development Department
pou a Building Division
11707 E. Sprague Avenue Suite 106
400010Vall
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: /C50„;. /-3 1--
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: (fie. eav f
Building Permit I I Change in Use Grading Manufactured Home
I I Relocation [( Tenant Improvement Fire Safety I I Other
OWNER/APPLICANT INFORMATION
o
n Owner:Hv--eLC c 0:1-0 ❑ Applicant:
Phone: Gj,20-175f Fax: Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
Contractor: +L . ,� n Architect:
Phone: ~2,a ,_ a c.y���6,—1/c, Phone: Fax:
Address: / ,/8 a,, fir--c.c.--. Address:
4c,-� LUw c7 9>G i'
Cit State Zip Code City State Zip Code
WA State Contractor License #: 2oa k._4C_9I eJPIC Contact: , a---y,--r,ti
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
MAIN FLOOR TO SQ. FTG: 2"" FLOOR SQ. FTG: 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:
COST OF PROJECT: 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
(it 1/5-6 0. ® SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash E Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard#: Expi
_- res: VIN#:
Authorized Signature: >'''( 7-c-ep.___ ---(