2003, 10-29 Permit App: BLD-03-02927 Reroof cr01"\fattik
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4 0 0 0" 'Y 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: YpT/ Al
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:go.7Z/s7;
01 BUILDING PERMIT CI CHANGE IN USE a GRADING a MANUFACTURED HOME
®RELOCATION Et SIGN DI TENANT D OTHER
OWNER / APPLICANT INFORMATION
CI OWNS 2 L�- lides'U%yi�i ® APPLICANT:
PHON : FAX: PHONE: FAX:
ADDRESSt' O jt /9/O?3 � Gve 994-12/9' ADDRESS:CITY,STZIP CITY,STATE,ZIP
®CONTRACTOR:C9' >'( iOgf"//if CI ARCHITECT:
PHONE:Cf�? VoW2 FAX: PHONE: FAX:
ADDRESS / / G-.74i !0/4eca-4/LvA / ADDRESS:
CITY,.STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 3 f�'X
Cre—' 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.
VISA
CASH CHECK
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE: