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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#: