2003, 08-18 Permit App: BLD-03-02257 Tear Off, Reroof /e 1%**
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d00"alle 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 I
STREET ADDRESS: d)g la S e (1 h") l c.'-?✓ i
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: izt r-o 0 r- - (T fv -04-
BUILDING PERMIT EI CHANGE IN USE a GRADING CI MANUFACTURED HOME
®RELOCATION Q SIGN 0 TENANT C OTHER
1 OWNER / APPLICANT INFORMATION
® OWNER: q ed CO/9g o,",of ® APPLICANT:
PHONE: FAX:: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STAT ,ZIP CITY,STATE,ZIP
, S 7L tqLodh) ®
CONTRACTOR: ARCHITECT:
® CR�
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PHONE: / 6 0-S7a6 AA-5/e4:
92/ —96-S"7 PHONE: FAX:
ADDRESS: /6 )0)0 £ ' !`1 S / C7 -.14 ADDRESS:
CITY,.STATE,ZIP / CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# igf S T e/14664/6 CONTACT: cc/ �`j�2�
PERMIT/BUILDING INFORMATION f
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COST OF PROJECT: 45/ 0(60 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:
1 DATE: I STAFF: I
METHOD OF PAYMENT:
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ilwattIV, VISA
CASH CHECK Sigiiiteirei
BANKCARD#: EXPIRES: VIN#
AUTHORIZED SIGNATURE::
..�A%A0.....I,.....r .fart.I ArIr.&I UM I AIM V QCenr_GaTFn WITH MAJOR BANKCARD