2004, 11-29 Permit App: 04009193 Re-Roof• ofe\ft,
Sun kane
Valley
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E, Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
Street Address:
REQUIRED SITE INFORMATION
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
Building Permit
-1 Relocation
17
Fc Weir -64.
(1 Change in Use IJ Grading 111 Manufactured Home
[1 Tenant Improvement fl Fire Safety I Other
OWNERJAPPLICANT INFORMATION
Owner:
f 6ket--<•ZilAa der
Phoneff eier6q Fax:
Address: ivizz-,-.F rrik 4,v
WeNbu
State Zip Code
Contractor:
Phone:
Address:
Fax:
City
State Zip Code
Applicant: >NI/1E
Phone: Fax:
Address:
City
State Zip Code
Architect:
Phone: Fax:
Address:
City
State o e
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/CON/, PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT/ az cx.)
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
El Cash
Bankcard #:
Authorized Signature:
Check
E
Mastercard
Lil VISA
Expires:
ID Other
VIN#: