2003, 10-14 Permit App BLD-03-02770 Re-RoofNUMBER of BEDROOMS:
DATE:
1
METHOD OF PAYMENT:
CASH CHECK
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Valley
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: 1 1109
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ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: -Tea v-i.�tl O CP 01rO 'rcot Ie€p LCs c n
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OWNER / APPLICANT INFORMATION
® OWNER: ® APPLICANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE, ZIP
®CONTRACTOR: 0L0C) P g ® ARCHITECT:
PHONE: FAX: PHONE:
ADDRESS: ADDRESS:
CITY, STATE, ZIP
CITY, STATE, ZIP
FAX:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # CONTACT:
PERMIT/BUILDING INFORMATION
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COST OF PROJECT: c-2t5 30% SLOPES ON PROPERTY:
BUILDING HEIGHT TO PEAK:
OCCUPANCY GROUP:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
1
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
STAFF:
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VISA
BANKCARD#• EXPIRES: V/N#
AUTHORIZED SIGNATURE*