2006, 08-09 Permit App: 06003123 Reroof MAY 18 2004 09:58 FR TO 8910527 P.01/06 nl Z 3
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S .� BUILDING PERMIT APPLICATION WOKSHEET
�lle City of Spokane Valley Community Development Department
Building Division
Va!
11707E SpragueAvenue, Suite 106
ev Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
.
Street Address: 12104 E. 22nd. Ave. Spokane Valley WA 99206
Assessor's Tax Parcel Number(s):
Legal Description: _
PERMIT DESCRIPTION: New roof installation with Elk 40 year material
a Building Permit ❑ Change in Use El Grading
❑ Relocation 0 Tenant Improvement ❑ Fire Safety 0 Oth�factured Home
OWNER/APPLICANT INFORMATION
c Owner. Herb Reinhardt .
Phone:924-4943 � - ❑ Applicant: Same as contractor
Fax: Phone: Fax:
Address: 1 �1 04 E. 22nd Ave Address:
Spo. Valley WA 99206 — -
City s State Zlp Code City Stats Zip Code
Contractor; Nat' 1 Roo ar e, orp. ❑ Architect: _
Phone: 926-0762 Fax: 891 -0527 Phone: Fax:
Address: 13801 E. Trent Ave. Address:
*� Spo. Valley WA 99216
eir�J' J J . City Stats zip eccgd City State Zip Code
, ' WA State Contractor License#:NATIORCO83N5
Contact: Roger D. Boucher
L____ PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #I OF STORIES:
MAIN FLOOR TO SQ. FTG: 2 FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SO. FTG: GARAGE SQ. FTG: - DECK/COV, PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF PROJECT: 30%b SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
8,389. 00
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
0 Cash a Check a Mastercard
El VISA ❑ Other
Bankcard#: _ Expires: VIN#:
Authorized Signature: