2003, 07-14 Permit App: BD-03-791 Reroofe
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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 INFO MATION
STREET ADDRESS: 4 Q
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: ri
a BUILDING PERMIT
® RELOCATION
EI CHANGE
D SIGN
a GRADING
TENANT
EI MANUFACTURED HOME
ii
OfIIER
OWNER / APPLICANT INFORMATION
® OWNER: -�
72-e/V)/
PHONE: FAX:
ADDRESS: 7 3 5.--Z' • -3 7
CITY,STATATE,2I
®CONTRACTOR: ?b Q 7 �� (^ ® ARCHITECT:
® APPLICANT: az:e ( ?e, (` l
PHONE:�� C' 07 / 3 FAX: c/4
,99•2�/DRESS: 6769,77/E
AD
CITY, STATE, ZIP
PHONE:I��`!
ADDRESZW
FAX: 7 Lv PHONE:
�/ S �r p�ADbRESS:
CITY,.STATE, ZIP
WA ST CONTRACTOR LICENSE
# / G 7C / -6-7UONTACT:
FAX:
CITY, STATE, ZIP
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
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:
METH • D O PAYMENT:
CASH CHECK
STAF
VISA
BANKCARD #; EXPIRES: V/N#
AUTHORIZED SIGNATURE::
*PAYPIl PRRu1T APPI InATIAAIR UM 1 AM V RF ACCFPTFf WITH MAJOR BANKCARD