2003, 09-12 Permit App: BLD-03-02460 Siding crrs of
Spokane
Valley 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: /DCO
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: .5-I p ! ►-�� p-Y1 �`( (
0 BUILDING PERMIT 0 CHANGE IN USE 0 GRADING a MANUFACTURED HOME
®RELOCATION Q SIGN D TENANT Q OTHER
OWNER / APPLICANT INFORMATION
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OWNER: F � - d -4111 _ 0 APPLICANT: t n -`
PHONE:92-2-2-V-/- 41/S- FAX: PHONE: FAX:
ADDRESS:
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, /.' )ZOOADDRESS:
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CITY,S ATE,ZIP CITY,STATE,ZIP
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CONTRACTOR: ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION f
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: I STAFF:
METHOD OF PAYMENT'
CASH CHECK VISA
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE: