2004, 04-12 Permit App: BLD-04-04043 Reroof BUILDING PERMIT APPLICATION WORKSHEET
•- City of Spokane Valley Community Development Department
Splekane Building Division
11707 E. Sprague Avenue Suite 106
4010V
ale Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE t FORMATION D - o-
I n �r
Street Address: pa al 91- a 1 9J
Assessor's Tax Parcel Number(s): la -73
Legal Description:
PERMIT DESCRIPTION: - Pl F
Building Permit Change in Use Grading Manufactured Home
I Relocation ( I Tenant Improvement n Fire Safety n Other
OWNER/APPLICANT INFORMATION
Owner: fl r 14/100#/h.F/l Applicant:
Phone: Fax: Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
Contractor: 0 Pe fle d OR( . n Architect:
Phone: qqq-jo7qS Fax: 5.31-1-3L166 Phone: Fax:
Address: 4C Se,�, Address:
S:iok;. li��. 92
City / State Zi2Z?
p 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 PROJECT: 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
37�Q SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
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Expires: VIN#:
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