2004, 10-08 Permit App BLD-04-07875 Re-RoofOCT 08 2004 09:05 FR
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TO 12086640974 P.01/01
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: 1-4-1,L. 1J v n i w t rs s-k�
Assessor's Tax Parcel Number(s): S 1 3 c Z c
Legal Description:
PERMIT DESCRIPTION: tom-
❑ Building Permit
❑ Relocation
pi * l0°I 13
❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
/
Owner. " Sand \. p \-4h - d Applicant:
Phone: L'3 ,`1 6�-4° 4 Fax: Zcs - 6c Li - cq�'f Phone: Fax:
Address: 8 i 8 (Ls,A.Q ,wz, Sk Address:
',.J01c"c2" Ic,. .g3Y-13
City Stabs Zip Code City State Zip Code
❑ Contractor ❑ 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:
MAIM FLOOR TO SQ. FTG:
2'`" ' FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG: _
GARAGE SQ_ FTG:
DECKICOV. PATIO SQ_ FTG:
OCCUPANCY GROUP:.
. CONSTRUCTION TYPE:
HEAT SOURCE: i r
. # 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 #:
)Zis Check ❑ Mastercard
Expires:
Authorized Signature:
❑ VISA
D Other
VIN#: ..,
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