2003, 12-02 Permit App: BLD-03-03177 RemodelPERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
99707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
$BU1LDING PERMIT ® CHANGE IN USE 0 GRADING
U RELOCATION [3 SIGN CI TENANT
MANUFACTURED HOME
D O'IHER
OWNER / APPLICANT INFORMATION
® OWNER: VViaAV
APPLICANT:
PHONE: I-,1? o(S-/'/ FAX: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
ADDRESS: ,Z!.( 5- N ' 6u,71v-,v^- a
f'd<ov-e i)a.0-adc[,,f4- 4921Y,STATE,ZIP
CONTRACTOR: (-4 m) dor g 7eut..i7Dp.3p /AC- ® ARCHITECT:
PHONE: 531/— Z ZC.O7 FAX: 53Ca `Z2C'O PHONE: FAX:
ADDRESS: 6:76r-KovY•-21 u.) 0 `!9 Z) e-- ADDRESS:
CITY, STATE, ZIP CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # 4-2191ziLi'0 /Co i)7 CONTACT:
COST OF PROJEC
PERMIT/BUILDING INFORMATION
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
OCCUPANCY GROUP: 2N0 FLOOR SQ FT:
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:
IMPERVIOUS SURFACE AREA: