2004, 09-21 Permit App BLD-04-07707 Re-Roof-Wiley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: 3 v
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTI ON:
PERMIT
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OWNER / APPLICANT INFORMATION
OWNER: eARaw a- S), qr6� fps/
PHONE: •J FAX:
ADDRESS:
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PHONE: 24 Os ale
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WA ST CONTRACTOR LICENSE
FAX: 9071 96 5"
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CITY, STATE, ZIP
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APPLICANT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
FAX:
ARCHITECT:
PHONE:
ADDRESS:
CITY, STATE, ZIP
PERMIT/BUILDING INFORMATION
COST OFPROJECT:IS %d CP
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
DATE:
30% SLOPES ON PROPERTY:
MAIN FLOOR SQ FT:
OCCUPANCY GROUP: 2ND FLOOR SQ FT:
CONSTRUCTION TYPE: UNFIN BASEMENT:
STRUCTURES ON PROPERTY: FINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
STAFF:
METHOD OFPAYMENT:
0
CASH
CHECK
BANKCARD #•
VISA
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EXPIRES: VIN#
AUTHORIZED SIGNATURE
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