2004, 08-23 Permit App: BLD-04-07419 Reroof BUILDING PERMIT APPLICATION WORKSHEET
n' - City of Spokane Valley Community Development Department
potaneBuilding Division
11707 E. Sprague Avenue, Suite 106
400010Valley
Spokane Valley, WA to99206
Phone; (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: /1 7u ', t . r7
Assessor's Tax Parcel Number(s):
Legal Description: L-e-r Dr/&11.- dosis i--r 4fr - LaY.4Y-
PERMIT DESCRIPTION:
I Building Permit ❑ Change in Use n Grading [ Manufactured Home
fl Relocation ❑ Tenant Improvement ❑ Fire Safety (1 Other
OWNER/APPLICANT INFORMATION
LI Owner: mai IC ii ‘.rt, 0 Applicant:
Phone: 'z7-Gr3/ Fax: Phone: Fax:
Address: //709 e- 37 Address:
City State Zip Code City State Zip Code
❑ Contractor: ,4 ,çFo<ta n1W 404No- n Architect:
Phone: /2.9 6 js ti Fax: - Phone: Fax:
Address: /toil N:Na,.es-k ,l A,e Address:
1.1. i')-y Laid L04 94015
City State Zip Code City State Zip Code
WA State Contractor License#: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK DIMENSIONS: #OF STORIES:
8'
MAIN FLOOR TO SQ. FTG: 2Nu FLOOR SQ. FTC: UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FIG: GARAGE SQ. FTC: DECK/COV. PATIO SQ. FTC:
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST,,QF PROJECT: 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
-"ZZdc! ,uo SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature: