2004, 06-28 Permit App BLD-04-04753 Re-Roofpokane
.00017alley
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: / / 5 2 2) Ur 4 4!/' (ill 4y
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: R , -
❑ Building Permit ❑ Change in Use ❑ Grading
fl Relocation P1 Tenant Improvement ❑ Fire Safety
-2/t
I) 2/(0 6'
_ Manufactured Home
❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: l A e.,./
Phone: • Fax:
Address: L / S".2. z 313?-, _41).,
Sp', 14 doe — 4,: d l/ 4
City / Slate Zip Code
0
Applicant:
Phone:
Address:
Fax:
City
State Zip Code
❑ Contractor: D t, 4 c.-s ❑ Architect:
Phone: 2 3 g- 4/ 7 z( Fax: - Phone: Fax:
Address:
Address: f yy"/
// yf . SGct
City State Zip Code
City
State
WA State Contractor License #: Contact:
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2'N'E FLOOR SQ. FTG:
UNFIN BASEMENT SO. 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:
c%L'" 7 • .?"--
30% SLOPES ON PROPERTY:
SEWER OR ON -SITE SEPTIC
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash
Bankcard #:
Check
❑ Mastercard
❑ VISA
❑ Other
Expires: VIN#:
Authorized Signature: