2004, 01-09 Permit App: BLD-04-03387 Repair Fire Damage Repairrnrut• /�q
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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
I
STREET ADDRESS: I 3 Z.
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: (JAp1ZF
.OEUILI)ING P-ERMTT
O RELOCATION
Acxw‘c1/4 Oath- , STOnr -\ 04' G -oro q 2
O CHANGE IN USE •® .GRADING O MANUFACTURED HOME Cl
0 SIGN ]-TENANT
O OTHER
OWNER / APPLICANT INFORMATION
OWNER: `` )rc 'or) OV'
APPLICANT:
PHONE: SJ ' ORI -?N37 FAX: PHONE: FAX:
ADDRESS: \ �'pZ.O t (JIM..o. #Q •s n l t33ADDRESS:
\ CITY,STATE, ZIP - CITY, STATE, ZIP
®CONTRACTOR: 0 ARCHITECT.:
PHONE:
ADDRESS:
CITY,. STATE, ZIP
FAX: PHONE:
WA ST CONTRACTOR LICENSE #
FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
F
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 3, 000
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:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
1
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK: