2003, 09-08 Permit App: BLD-03-02408 Tear Off, ReroofSp�Me
„'Valley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEYCOMMUN/TY DEVELOPMENT
BUILDING DIVISION
19707 East Sprague Ave Ste 906
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
1 REQUIRED SITE INFORMATION
STREET ADDRESS: TO .4/ rP /(
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: no cQcdr--
® BUILDING PERMIT Q CHANGE IN USE 0 GRADING 0 MANUFACTURED HOME
®OTHER
® RELOCATION
® SIGN- Q TENANT
1
OWNER / APPLICANT INFORMATION
r
. ® OWNER: .L7cv I� / t 2/Cald
PHONE: 997/ U`&I? / FAX: /
ADDRESS: /V j'cTIY C e//f"� /7,A
CITY,STATE, ZIP
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CONTRACTOR: ARCHITECT:
® APPLICANT:
PHONE: FAX:
ADDRESS:
PHONE: FAX: PHONE:
ADDRESS: ADDRESS:
CITY,. STATE, ZIP
CITY, STATE, ZIP
FAX:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE CONTACT:
COST OF PROJECT:
30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2N0 FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS:
GARAGE:
zo'.
METHOD OF PAYMENT:
®
0 ® f
en
CASH CHECK
VISA
BANKCARDA'• EXP/RES: VIN+(E
AUTHOR/ZED SIGNATURE
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