2003, 09-29 Permit App: BLD-03-02621 Change of Use CITY 1F 0"railtek.
A✓
4,000Vailey
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: /z, _ (AA
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: CktAyp &F (A.%p &c (e)c' 4-0 .
U BUILDING PERMIT 0 CHANGE IN USE 0 GRADING a MANUFACTURED HOME
®RELOCATION Q SIGN of TENANT E OTHER
OWNER / APPLICANT INFORMATION
® OWNER:/ 7 I (ei - ® APPLICANT:
PHONE: c1 Z 7- LI e,e/f� FAX: / PHONE: FAX:
ADDRESS: ZZ S- r/� Ue40.6p-� ,Jo ADDRESS:
0 CITY,STATE,ZIP r-j'C/037 CITY,STATE,ZIP
®CONTRACTOR: ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 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:
IDATE: I STAFF:
METHOD OF PAYMENT: -
0111111111111111
CASH CHECK
f VISA
useame
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE: