2004, 09-16 Permit App: BLD-04-07663 Tear Off, Reroof ' gr" 1."\"'"e
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
IREQUIRED SITE INFORMATION I
STREET ADDRESS: / y0 c2 4—,
/ 9
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: 7; i - I- ,�.Q K)4 -
0 BUILDING PERMIT 0 CHANGE IN USE a GRADING a MANUFACTURED HOME
®RELOCATION D SIGN Q TENANT ®-OTHER
1 OWNER / APPLICANT INFORMATION
® OWNER: f(3 1F-161./L ® APPLICANT:
PHONE: FAX: PHONE:
FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
°CONTRACTOR:_ 4A T RESROOFING, INC 0 ARCHITECT:
PHONE: E. 10712,01ISSION PHONE: FAX:
SPOKANE, WA 99206
ADDRESS: BESTRIA '406, ADDRESS:
926-0526 'STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION f
COST OF PROJEC Jf a� 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: 1 STAFF:
N.
METHOD OF PAYMENT: /
0 0 0 , TT E " wn
hlafi - VISA
CASH CHECK
BANKCARDS; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*GAiii Gf1 fo*IIT A nn/IA ATIA►IL�IA/11 I III V sr A _ TGf11AII rLI AAA 1A15 15 A►I/t"Anr►