2005, 03-21 Permit App: 05000840 Reroofmar Li. UD
OCT 19 2003 12:37 FR
do, Vailey
TO 5320693
P.02/04
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PERMIT APPLICATI9N WORK SHEET
SPOKANE VALLEY COMMUNITY OEVEL OPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokana Valley, WA 99206
Phone; (509)688-0036 Fax: (509)688-0037
STREET ADDRESS:
RE
WIRED S
TE INFORMATION
I vy
ASSESSOR'S TAX PARCEL NUNSER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: vcv c
°BUILDING PERMIT
FIELD CATTON
CUAN GE IN USE 13 GRADING DMANUFACTUXED SOME
Ct OTHER
Ct SIGN D TENANT
OWNER / APPLICANT 1NFORMATION
OWNER;
PHONE:
p
FAX•
0
APPLICANT:
,PHONE: FAX:
CITY,STATE, ZIP ADDRESS:
ADCRESS:
°CONTRACTOR! LD-- \n i2 -00.A rs.
PHONE: 93) 53 -,-"'s '3 L FAX: ( s C:'5? -1 - DS 93
ADDRESS; /301 C Oke
WA ST CONTRACTOR LICENSE N
CITY, STATE, ZIP
ARCHITECT:
PHONE: FAX:
ADDRESS:
Cfre.STATE ZIP CITY, sTATE, ZIP
LA-NGke_Y- P -5 -ACT;
PERMIT/BUILDING INFORMATION
COST OF PROJECT: (53 C I L)--° 30% SLOPES ON PROPERTY: PAAIN FLOOR SQ FT:
BUILDING HEUHT TO PEAK: OCCUPANCY GROUP: ro FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT.
NUMBER OF STORIES: STRUCTURES ON PROPERTYFINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
NUMBER cif BEDROOMS.
0
CASH CHECK
REDACTED
&AMMAR° At
AUTHORIZED SIGNAITURK
MAR 11 2005 11:17
iftE&SED ACrED vfNo
Thit--locument originally contained
confidential credit card information which
was redacted pursuant to RCW 19.255.010
and the original document destroyed
pursuant to SOS DAN GS2014-030.
,J 7
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