2004, 09-08 Permit App: BLD-04-07594BUILDING PERMIT APPLICATION WORKSHEETomm
C-Ic1�1't City of Spokane Valley Community Development Department
} Ke Building Division
11707 E. S ra ue Avenue, Suite 106
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Valley Spokane Valley, WA 99206
Phone; (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address:
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: tear D {�` — re rl)�)�
❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner:
DIMENSIONS:
Phone:
Fax:
Address: 1 r =q (�
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
Cil
state Zip Code
❑ Contractor:
Aa -4- &06&d
Phone: �V
/9-2,o y Fax:
Address: ����
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COST OF PROJECT:
S cl) I
30% SLOPES ON PROPERTY:
Cit
State Zip Code
WA State Contractor License #:
❑ Applicant:
Phone:
Address:
city
❑ Architect:
Phone:
Address:
City
Contact;
PERMIT/BUILDING INFORMATION
Fax:
State Zip Code
Fax:
State Zio Code
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:
S cl) I
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 ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature: