2003, 12-03 Permit App: BLD-03-03194 Trusses, RoofingSton kaner e
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BU/LD/NG DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: la (3C -2_ O
rs DC -51k T
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
UILDING PERMIT
RELOCATION
4,2 •
0 CHANGE IN USE ® GRADING
®SIGN CITENANT
MANUFACTURED HOME
C OTHER
OWNER / APPLICANT INFORMATION
® OWNER: ® APPLICANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE, ZIP
2
CI -CONTRACTOR: I -ow -Q Pc -55 C O* ST2-0CCPi RCHITECT:
PHONE:S7C‘c — SSc-c3� FAX: ,���j I� 619
PHONE: FAX:
ADDRESS: 'Z-"\ 2 4v L`-� V r� I9IADDRESS:
CITY,. STATE, ZIP
WA ST CONTRACTOR LICENSE # C-0 'v f -c( vi -(30
CITY, STATE, ZIP
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT COD
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:
OCCUPANCY GROUP.
CONSTRUCTION TYPE: UNFIN BASEMENT:
STRUCTURES ON PROPERTY: FINISHED `BASEMENT:
CRITICAL AREAS: GARAGE: \-trc vtpz
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
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