2005, 07-29 Permit App 05002657 Re-Roof0001%,
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dossoValley
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: /0(, / , M !SSID" A V e—
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: ii --{y& �2 -{- - Cj(_ 't
U1LDfNG PERK
RELOCATION
a CHANGE IN USE • • aGRADfNG
a MANUFACTURED URED .HOY[E
®•SIGN 0-TENANT ,I"__10EHER fie O-e-a
OWNER / APPLICANT INFORMATION
® OWNER:
PHONE:
b((.t af r8//
FAX:
ADDRESS: / O e0 / / +l l5 S) v '�
CITY,STATE, ZIP
(AAt e WA 99� o c�
CONTRACTOR:
PHONE:
FAX:
ADDRESS:
CITY,.STATE, ZIP
® APPLICANT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
. WA ST CONTRACTOR LICENSE # -
ARCHITECT.:
PHONE:
ADDRESS:
FAX:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 6 0 0
BUILDING HEIGHT TO PEAK: /3
BUILDING DIMENSIONS:'2'6" X 31-
NUMBER OF STORIES: /
NUMBER of BEDROOMS:
DATE:
30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
OCCUPANCY GROUP:.
2N1) FLOOR SQ FT:
CONSTRUCTION TYPE: 5/u.Ck0 UNFIN BASEMENT:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
FINISHED BASEMENT:
GARAGE:
STAFF:
METHOD OF PAYMENT:
113
CASH CHECK
® I ;
VISA
�7?
BANKCARD #;
EXPIRES: VIN#
AUTHORIZED SIGNATURE.
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