2003, 09-09 Permit App: BLD-03-02421 Finish Basement SCrikikan4":1411"*" • ' 4
Vaiieiy 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 I
// ()STREET ADDRESS: & r / p e o 2a
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
Al BUILDING PERMIT a CHANGE IN USE a GRADING a MANUFACTURED HOME
®RELOCATION ®SIGN 0 TENANT lig OTTER
1 OWNER / APPLICANT INFORMATION 1
® O �' n i'cid" C':✓' . ® APPLICANT: , '. Ze l't . 74
WNER: i ,
PHONE: 7X -,?-5:,?? FAX: PHONE: 7( - /G 6 / FAX: 76- -l47 7r:7
ADDRESS: ADDRESS:
/ CITTY,STATE,ZIP CITY,STATE,ZIP
®CONTRACTOR: '1-7 4..) ,'/le-- ® ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIPCITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# /r. //
P Li/J, c // (.CONTACT: ‘7,-,,, /9/'-'//2
`I PERMIT/BUILDING INFORMATION
1
COST OF PROJECT CO 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:
- -- -- J
METHOD OF PA YMENT.
a a ® I 0 irnom ..
VISA
CASH CHECK ._ -4._..- INIMINSONS
BANKCARDit EXPIRES: V/N/I
AUTHORIZED SIGNATURE:
*GA VGM SG�aiIr A mins inakoriettia IAI11 I AA11 V nG AnncoTCn UWTU IIA IAD DAIIVf`ADA