2003, 09-18 Permit App: BLD-03-02507 PoolPERMIT 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:
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: 5 Inz ( 1/21 14-1 tA) Pce 2-6
UILDING PERMIT
RELOCATION
CI CHANGE IN USE 0GRADING °MANUFACTURED HOME
0 O'FHER
D SIGN Q TENANT
OWNER / APPLICANT INFORMATION
1
° OWNER: frLiOK /IL, -e "
PHONE: /)-0( if FAX:
ADDRESS: /t/. L( 6066/7.'
CITY,STATE, ZIP
133r 0
CONTRACTOR: / —( ARCHITECT:
PHONE: 3 ') -5 5"1 FAX: `(777 PHONE: FAX:
1:11 APPLICANT: 0--e 4 1(1. L
PHONE: -3 / 5- t1 FAX: 13 S --Ll772
ADDRESS: k- u 4-4/4 (c—e/ . 2-0
/CITY, STATE, ZIP
ADDRESS: )11 6((Q0 1,1 kj-,• ADDRESS:
TY, STATE, ZIP CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # A-1 G-Fiti C r0 CH 10 1 CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT': "d-- Li( -11A 30% SLOPES ON PROPERTY:
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK: 100(
REAR SETBACK:
LEFT SETBACK:
1 1/ (
RIGHT SETBACK:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY: i-1lOv5
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK:
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A-1 CENERAL''CAAITAACTORS INC
FIRS -1'10 SERVICES `
6410 N: MONROSOK NE WA� 9920 ' _
(506) 8-3064g1t NC109101. --.._- ; •-
SEP 15 2003 14:54
5093241567 PAGE.01
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FINAL d'S�E3UII� I1 iAI LLAT ION
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1
try r".44 /b0-4('%.42/41
•�t`� 3
T1i LOCATION OF THE ONSITE SEWAGE
SYSTEM REPRESENTED BY THE DRAWING
15 NOT TO BE CONSTRUED AS AN
EXACT LOCATION OF THE SYSTEM
' REMARKS (continued):
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