2004, 07-15 Permit App: BLD-04-07069 Tear Off, Reroof ' BUILDING PERMIT APPLICATION WORKSHEET
SCI
TY City of Spokane Valley Community Development Department
potane Building Division
11707 E. Sprague Avenue Suite 106
400100V
ale Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: / / Vim Yer lai.° l)4 _ ..',37
i
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: AO -/~2 1
,A Building Permit (l Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
1, Owner: en' C i>///of Applicant: jPj7 Cow/ /-
Phone: �/-XU// Fax: Phone: %-f1U// Fax:
/ �1Z
Address: , /1./r/'tf' Address: y/ f %4/fA-
L/e r6 rJ /thy /,..5-Y/ /V P37 lif',/a e , z,04
City State Zip Code City State Zip Code
_ Contractor: I I 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: 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 PRO ECT: 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
O2) OD, s SYSTEM?
(Method of Pyent: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash Y Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature:
...
•
t .
,
--N.
��
.)--, \
'
\`\
.s\
\,,
1
`,\
1