2004, 10-07 Permit App BLD-04-07871 Re-Roofsii�iCt
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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: 77 0?-c% i n:
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: t4»
❑ Building Permit E Change in Use /
❑ Relocation g C Grading El Manufactured Home
❑ Tenant Improvement ❑ Fire Safety C Other
OWNER/APPLICANT INFORMATION
Er-
Owner: or []5&Applicant: -C-
Phone:/y77 tiro Fax: Phone: Fax:
Address: i yp 91 Address:
wa C/'�za‘
City'% State Zip Code City State Zip Code
[ibontractor: s/¢i, - 2
E 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:
�Q.
MAIN FLOOR TO 3Q. FTG:
2ft-' FLOOR SQ. FTG:
UNFIN BASEMENT FTG:
FINISHED BASEMENT SQ FTG:
GARAGE SQ. FTG:
DECKICOV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT: mm-r-&
/00e) oc
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 #:
g-2heck ❑ Mastercard
0 VISA
❑ Other
Expires: VIN#:
Authorized Signature: