2005, 10-13 Permit App 05003823 Demo Garage, Chicken CoopSkme
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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:
Assessor's Tax Parcel Number(s): .55-0 ? 3 . t 5 4c
Legal Description:
CA-C!-70
D. Manufactured Home
❑ Tenant Improvement ❑ Fire Safety a Other
PERMIT DESCRIPTION:
❑ Building Permit
❑ Relocation
❑ Change in Use ❑ Grading
OWNER/APPLICANT INFORMATION
Owner:
Phone: 3z G (35 Fax:
Address:
City
Contractor:
Phone:
W/1.-- 9'2.0
State Code
Address:
Fax:
City
State
Zip Code
WA State Contractor License #: LA-R)5 0 Di- t
Applicant
Phone: I5 >
Address: P.O
chi f Fax: S3 - g047
( -c IFS 3S-
C.d./4 cqz
City / State Zip Code
Architect:
Phone:
Address:
Fax:
City State
C ntact: �. ,t,4/ 56 j1/
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES: /
MAIN FLOOR TO SQ. FTG:
21'" FLOOR SO. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG: 0DECK/COV.
PATIO SQ. FTG:
OCCUPANCY GROUP:-
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
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 #:
Authorized Signature:
❑ Check
❑ Mastercard
❑ VISA
Expires:
❑ Other
VIN#:
89-23-05 08:13PM FROM-SCAPCA
5094776828
T-171 P-01/01 F-714