2003, 10-14 Permit App: BLD-03-02777 Reroof1
Supokane
valley
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: l-1 L3 n ' Lo c �d • iCLU H
S ' Valle4.\ i Wes '192 b
ASSESSOR'S TAX PARCEL NUMBER(S): u U
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: QF _Z o- e!(' P k,14S'it—kirk% I x
O BUILDING PERMIT ID CHANGE IN USE 0 GRADING
®RELOCATION
®SIGN QTENANT
MANUFACTURED HOME
® OTHER
1
1
OWNER / APPLICANT INFORMATION
1
® OWNER: 2:%\ - Ski (1,1 d' `a \ l'elr_
PHONE 17jf) 1 C124-7_23 ( FAX:7
ADDRESS: 41 i Yl. LQn-v 1�u• SCYnnP iblfie
x
�I���['.,.C�n ,STATE, ZIP 7`
°CONTRACTOR: ISN�n ag, nub I �Q/\)
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
• APPLICANT:
PHONE:
,L' ADDRESS:
2110
® ARCHITECT:
PHONE:
ADDRESS:
FAX:
CITY, STATE, ZIP
FAX:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:I/1000
30% SLOPES ON PROPERTY:
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP:
BUILDING DIMENSIONS: CONSTRUCTION TYPE:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
METHOD OF PAYMENT:
CASH
CHECK
VISA
BANKCARD A,• EXPIRES:
AUTHORIZED SIGNATURE'
VIN#