2004, 05-14 Permit App: BLD-04-04349 Tear Off, Reroof BUILDING PERMIT APPLICATION WORKSHEET
n'prc - r City of Spokane Valley Community Development Department
Building Division
11707 E. Sue Avenue Suite 106
400,V .al SpP g
okane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFO MATION
Street Address: id 708 El. (Q' V
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: 1-AN -o-# 4 OCa y' 4C9-
n Building Permit Change in Use Grading 1 I Manufactured Home
1 1 Relocation n Tenant Improvement n Fire Safety n Other
OWNER/APPLICANT INFORMATION
Owner: ,92 (4)'e+ze" 1 n Applicant:
Phone: Fax: Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
�n Contractor: . 9 5-t- Kn bo ipy I I Architect:
Phone: %26-05-..26 Fax: gal- �6S``7 Phone: Fax:
Address: JO 7020 zi-_, iipSS7e/L- Address:
a-4 State Zip Code City State Zip Code
WA State Contractor License #: 't S7 'f/4063,t6 Contact: Le/ 272-""
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:7221v CJAA 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
// / SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check El Mastercard ❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature: