2004, 12-16 Permit App: 04009408 Reroof BUILDING PERMIT APPLICATION WORKSHEET
City of Spokdnel'alley Community Development Setn cx ent Department
ne Building Division
11707 E. Sprague
Avenue Suite 106
40000VallSpokane
Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION 1
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Street Address: I ( < I l VL .-c/-( 0
..,14Assessor's Tax Parcel Number(s):
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Legal Description: ��;; '
PERMIT DESCRIPTION: •A 2 C. ....6_e. _ — —'
(7 Building Permit ❑ Change in Use n Grading Manufactured Home
n Relocation n Tenant Improvement - Fire Safety Other
OWNER/APPLICANT INFORMATION
Owner: OX F / -%4'-L!