2003, 08-15 Permit App: BLD-03-02242 Tear Off, Reroof1
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Spokane's' e
Dalley
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
19707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: B 90 . Ea5k,IJ ro4) wety
ASSESSOR'S TAX PARCEL NUMBER(S):.C5)Sl/.35 b7
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: Tea,(' OTF I /'2-5-422t1 re - ✓ad
UILDING PERMIT 0 CHANGE IN USE 0 GRADING 0 MANUFACTURED HOME
(OTHER
QRELOCATION
®SIGN ®TENANT
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OWNER / APPLICANT INFORMATION
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OWNER: A9.}Q,s
® APPLICANT:
PHONE:7OCp-(/S'1I- 3 )) FAX:,P y 1,' PHONE: FAX:
ADDRESS: 16 +LDlk '�/• I ","' ""' w}#CI TP, ,STATE, ZIP4 ADDRESS: CITY, STATE, ZIP
°CONTRACTOR: b .1 C14- UUripy `_-, C•' -I ARCHITECT:
PHONE: �j 1-I9 1 l - 11 5' 8?- FAAX:5O 1'U k 9 LC+ PHONE: FAX:
ADDRESS: 15 i e
E. 4tAl tqn 1`-N I� 5p.Vy WA-
' �{9t &, ADDRESS: IP CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE ft Dirt K WI * O /Y 5 b v CONTACT:
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PERMIT/BUILDING INFORMATION
COST OF PROJECT? W).`J 30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: 2N0 FLOOR SQ FT:
BUILDING DIMENSIONS:YPE: UNFIN BASEMENT:
NUMBER OF STORIES: PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: GARAGE:
DATE:
METHOD OF PAYMENT
IE!
OCCUPANCY GROUP:
CONSTRUCTION T
STRUCTURES ON
CRITICAL AREAS:
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CASH CHECK
STAFF:
VISA
BANKCARD #,• EXPIRES: VIN*
AUTHOR/ZED SIGNATURE*
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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