2004, 10-27 Permit App BLD-04-08045 Re-RoofCITY OF
k e
Valley
- BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: Z31-4 •N CULam 3 Th
Assessor's Tax Parcel Number(s): 3 5124 3oD 3
Legal Description: COLEM - i c 'j\l el PT 62-
PERMIT DESCRIPTION:
L Building Permit
7 Relocation
t `HOC•
E Change in Use C,
❑ Tenant Improvement
Grading
Fire Safety
Manufactured Home
Other
OWNER/APPLICANT INFORMATION
Owner MtcrHzeL i.�ltnnr,ty
Phone: 994_-4At, I Fax: 9za- c2.4i
Address: z3ta'n1 Cca,,,),„„ Zt
S s€ V&u_ W k 9923z
City State Zip Code
Contractor:
Phone: Fax:
Address:
City
State Zip Code
WA State Contractor License #:
❑ Applicant:
Phone: Fax:
Address:
City
State Zip Code
n Architect:
Phone: Fax:
Address:
City
Contact
State
Zip Code
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:
t 3 Zccj
30% SLOPES ON PROPERTY:
SEWER OR ON -SITE SEPTIC
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash Jj Check
Bankcard #:
Authorized Signature:
❑ Mastercard
❑ Other
VIN#:
❑ VISA
Expires: