2003, 10-30 Permit App: BLD-03-02953 Licensed Care HomePERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILD/NG DIVISION
19707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:
30 C iv a Ac
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: �. / / @/'t, /S C /0 /g for N f S
®BUILDING PERMIT
®RELOCATION
llit;HANGE IN USE 0 GRADING 0 MANUFACTURED HOME
® SIGN ® TENANT
OTHER
OWNER / APPLICANT INFORMATION
ID OWNER: //72eri// %t_,/ei504
PHONE: ?2 ' 768/ FAX:
ADDRESS:
•
El
CONTRACTOR:
PHONE:
/YeS E el)/
® APPLICANT:
PHONE:
ADDRESS: •• '
V' Aile 6.49
• CITY,STATE, ZIP
4yaooCI
ARCHITECT:
FAX:
CITY, STATE, ZIP
FAX: PHONE:
FAX:
ADDRESS: ADDRESS:
CITY, STATE, ZIP CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE: UNFIN BASEMENT:
STRUCTURES ON PROPERTY: FINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
1
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
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