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2004, 05-25 Permit App: BLD-04-04446 Reroof BUILDING PERMIT APPLICATION WORKSHEET poR OF` - - City of Spokane Valley Community Development Department Sun' . 0 Building Division 11707 E. Sprague Avenue, Suite 106 4000Vall Spokane Valley, WA 99206 Phone: (509) 688-0036; Fax: (509) 688-0037 REQUIRED SITE INFORMATION Street Address: /302/5 t: /.5-7-1/ Assessor's Tax Parcel Number(s): <3.-.222 4/. .23 Siv Legal Description: PT N 7-RA c T /7 8j c%`R.4 PERMIT DESCRIPTION: PE-,--- Rcro A" I I Building Permit n Change in Use n Grading Manufactured Home I I Relocation n Tenant Improvement I I Fire Safety Other OWNER/APPLICANT INFORMATION El Owner: DouGLAs j4v'Gs7e,,J Applicant: Phone: g9/ 7673 Fax: Phone: Fax: Address: /3. i� 1-- /67/1 Address: SpoICA,v,F VAitAY 4.1.4 992d6 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: .23 3ox3y MAIN FLOOR TO SQ. FIG: 2N'FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: ,,a /020 .52D FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG: 5V 52z. - OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE: �/oao bAP4444' 64 S #OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA: 3 z©6.° COST Q CT: 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC SYSTEM? Sttdz,P Method of Payment: (Faxed permit applications will only be accepted with major bankcard) ❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other Bankcard#: Expires: VIN#: Authorized Signature: