2003, 10-02 Permit App: BLD-03-02648 Tear Off, Reroof 4.-00Valley
"l PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
91707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone:(509)688-0036 Fax:(509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: /3 7 O Z- _�
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: ZR a T> �, :�
OBUILDIING PERMIT a CHANGE IN USE a GRADING a MANUFACTURED HOME
RELOCATION D SIGN I TENANT 0-OTHER
OWNER / APPLICANT INFORMATION
OWNER: .0117c._.1-ver-e—y APPLICANT: �v /lea ✓ -
PHONE: yam' 7 6 y �� / FAX: PHONE: �� v1 07 FAX: ,5-1
ADDRESS: ADDRESS: - -jG 5 7f-/' ✓'��' + s:::„0
92 '7
CITY,STATE,ZIP 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:
DATE: f STAFF: -—._ ..... .
METHOD OFPAYMENT.:
VISACASH CHECK
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE.'