2004, 04-27 Permit App: BLD-04-04201 Tear Off, Reroof BUILDING PERMIT APPLICATION WORKSHEET
SC1TY W
- City of Spokane Valley Community Development Department
pokarie Building Division
E a
Sprue Avenue, Site 106
j Ta 11707 Spr gu
40000
�/ Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: / ? 117 ci 17 � .‘ }2i,<
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: K-Qkc,(iv/ k),-, 6-1.5;_cL. rt (- c (n)
K Building Permit I I Change in Use f I Grading I anufactured Home
Relocation I I Tenant Improvement n Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
I, Owner: ;..1,`- f C cry-, ' [1 Applicant:
Phone: 7:2A/_/-/( Fax: Phone: Fax:
Address: / 111/, -r ;7i1., Ave Address:
Cityl State Zip Code City State Zip Code
Contractor: r ,`l't,( \ n Architect:
Phone: Fax: Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES.
7_,- ' --�
MAIN FLOOR TO SQ. FTG: 2"D FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FIG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COS ;OF PROJECT: 30%SLOPES ON: PROPERTY: SEWER OR ON-SITE SEPTIC
/ �( .('rm SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash heck ❑ Mastercard ❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature: