2005, 09-19 Permit App: 05003460 Tear Off, Reroof FROM :BARTON ROOFING FAX NO. :5395354953 Sep. 19 2005 03:44PM P1 � /0
_ :_- - .
BUILDING PERMIT APPLICATION WORKSHEET -Iq'j -�-
On of City or Spokane Valley Community Development Depar_ment / C
elan
One . Building Division
11707 E. Sprague Avenue, Suite 106
4000 Valle ' Spokane Valley, WA 99206
1 Phone: (509) 688-0036;Fax: (509) GSW-0037
REQUIRED SITE INFORMATION
Street Address: 13421 East 12th _______
Assessor's Tax Parcel Number(s): _ ---
Legal Description:
PERMIT DESCRIPTION: Tear off, resheet, and roof -
Building4.
Permit Change in Use Grading ❑ Manufactured Home
O Relocation 0 Tenant improvement E Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ . Owner: John Clift _ ❑ Applicant: _ _
Phone: Fax: Phone: Fax: -
Address: SpmP Address:
ON Slate 92124e Cly !ale —2W rode
O044,AcciorE Barton Roofing ❑ Architect: .
5423 East Union Phone: - _._ Fax:_ __
Sr'nkane.WA 99212 Address:•
P 535-3768 F 931-5065 cin - State zip Cody
WA State Contractor License 4: ppgrb re,c 4071 Contact:
i --- PERMIT/BUILDING INFORMATION
HEIGHT TO PTO PEAK -DIMENSIONS: I $OF STORIES:
MAIN FLOOR TO SQ. FTG 1 2'FLOOR SQ. FTG: N IN BASEMENT SQ.PTO:
' UIt
FINISHED BASEMENT SQ.FTC: T GARAGE SQ.FTG; I DECK/COV.PATIO 60.FTG:
_ I - -1
OCCUPANCY OROUP: CONSTRUCTION TYPE: I HEAT SOURCE:
I
a OF BEDROOMS. I TOTAL NAS&TABLE SPACE. :MPERVIOUS SURFACE AREA:
COST OF PROJECT* t'-. ap Or--- 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
L___ — _ (C.A.)'.., �^ SYSTEM?—
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
0 Cash 0 Check IjZ] Mastercard VISA ❑ Other
BanKcarl;It: Expires: VIN*:
t71 1 s h -C
Authorized Signature:, � '. b .. '
Ki: TOTAL PAGE.02 x.t<
This document originally contained
confidential credit card information which
was redacted pursuant to RCW 19.255.010
and the original document destroyed
pursuant to SOS DAN GS2014-030.
SEP 19 2005 15:36 5095354953 PAGE.01