2003, 07-28 Permit App: BLD-03-02093 Tear off, Reroof1
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: S Il 1
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
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PERMIT DESCRIPTION: *eRr 6r(4€ 1P c — 1 6T'
BUILDING PERMIT 0 CHANGE IN USE
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OWNER / APPLICANT INFORMATION
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WNER: &Q le OW
PHONE: sD9473-2l7---7 FAX:
ADDRESS: Q, U I E -C4:17100
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® APPLICANT:
L / / PHONE: FAX:
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CITY,STATE, %NIeZIP WWLI Z
®ic • CONTRACTOR: ARCHITECT:
PHONE: FAX: PHONE:
ADDRESS: ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
CITY, STATE, ZIP
FAX:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: .LF fK, 3 1
•
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
DATE:
METHOD OF PAYMENT.
STAFF:
1
CASH CHECK
VISA
BANKCARD #; EXP/RES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD