2003, 09-22 Permit App: BLD-03-02547 Tear Off, Reroof crrsu� .
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIV/S/ON
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone:(509)688-0036 Fax:(509)688-0037
' REQUIRED SITE INFORMATION
STREET ADDRESS: C2 S. r (o,re S S
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION: Per °�cf- 7 gQ (i4)44
P MET DESCRIPTION:
BUILDING PERMIT a CHANGE IN USE a GRADING a MANUFACTURED HOME
®RELOCATION D SIGN fa TENANT BOTHER
OWNER / APPLICANT INFORMATION
® OWNER: �fl l (G/i.(&`1 ® APPLICANT:
PHONE: r 21-- et"1 FAX: PHONE: FAX:
ADDRESS: 60- S°P i y f;r<S5 ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
®CONTRACTOR: 4F(0,1-6A tJL.J ec'oc,n.) 6-�,/1/4-C ® ARCHITECT:
PHONE: S-' 3 Z d-4/7`'(r FAX: p�� PHONE: FAX:
ADDRESS: (Z�'( /J( 1.10.� � la- f"
esd i V t C- ADDRESS:
CITY,.STATE,ZI 5'gc,( 9 CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# A fro er1,2e0 6 AN CONTACT:
IPERMIT/BUILDING INFORMATION f
COST OF PROJECT: NEO UL)•u.i 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: 8e OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: I STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE:
IDATE: - - I STAFF:
METHOD OF PAYMENT:
0 0 0 . ,7 7 0 1..
maowsoff
CASH CHECK VISA
BANKCARD#; EXPIRES: V/N#
AUTHORIZED SIGNATURE'