2003, 08-18 Permit App: BLD-03-02256 Tear off, Reroof ,.
Sitikan'e\'` .
,, lley 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: /[ 0 �( E / ?T
11
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: 'R P_ -RtDp�
a BUILDING PERMIT EI CHANGE IN USE a GRADING a MANUFACTURED HOME
®RELOCATION a SIGN a TENANT aOTJIER
1 OWNER / APPLICANT INFORMATION
® OWNER: tJ `- D ® APPLICANT:
PHONE: 36407 FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
a
®CONTRACTOR: (. L. ` Z C.-L.1,6 5-(7( ARCHITECT:
PHONE: 2--20 G�q FAX: PHONE: FAX:
ADDRESS: P,6 c li CA---6 6 v-c-C,04S ADDRESS:
( A ` n , O ). CC CITY,STATE,ZIP KACONTACT: STATE,ZIP
WA ST CONTRACTOR LICENSE# G tel. v 7(2 c-Ac 3 O ,CONTACT:
PERMIT/BUILDING INFORMATION 1
COST OF PROJECT: ( 5666 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:
a a ` 7 ® 11111111111111111111EMINglifeh
CASH CHECK
I"�`` ';' VISA
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
IFI /Lun'r1 nouIr AIft121, IlArIALIC W11 I A1111 V DC Annra-mn WITIW MA.IAR RANKCARD