2003, 09-12 Permit App: BLD-03-02455 Reroofcrt y ()e
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,,;00Va11ey PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDINGDIVISION -
9 9707 East Sprague Ave Ste 906
Spokane Valley, WA 99206
Phone; (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:�-
ASSESSOR'S TAX PARCEL NUMBERS):
LEGAL DISCRIPTION:
PERM[T DESCMPTIOW kc- Rc�f�
BUILm% PERmrr 0 CHANGE IN .USE [.GRADING ®MANUFACTURED .HOME
[]RELOCATION 13SIGN 13TENANT ® OTHER
OWNER /APPLICANT INFORMATION
®OWNER:_J� 4� I�f \_iC. ®1
APPLICANT:
PHONE: 7A - �7�3 FAX: (� /f PHONE: FAX:
ADDRESS: 73-9 V lY���`Zg `�i�/G ADDRESS:
CITY,STATE, ZIP CITY, STATE, ZIP
13 CONTRACTOR: ® ARCHITECT:
PHONE: FAX:
ADDRESS:
CITY,.STATE, ZIP
WA ST CONTRACTOR LICENSE #
PHONE: FAX:
AD
CONTACT:
PERMIT/BUILDING INFORMATION
CITY, STATE, ZIP
COST OF PROJECT: `^?i�� 30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE:
DATE: E (dl STAFF:
METHOD OF PA YMENT.-
13
CASH CHECK
BANKCARD #;
AUTHOR/ZED SIGNATURE
E3 E3
VISA
C
VIN #