2003, 11-07 Permit App: BLD-03-03022 Reroof4•
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
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STREET ADDRESS: 'Lk(l N. OiclC �IJl�kren P.
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: Cecnob
a BUILDING PERMIT • ® CHANGE IN USE
®RELOCATION Q -SIGN
®GRADING
]-TENANT
® MANUFACTURED HOME
fOIUER
OWNER / APPLICANT INFORMATION
ROWNER: is k e-0(Je9\
PHONE: 51:r>t`I0/42Ul
FAX:
ADDRESS: .2-420 (Y PI
® CONTRACTOR: fl\ Wwfir
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CITY,STATE, ZIP
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE 11
® APPLICANT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
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ARCHITECT:
PHONE:
ADDRESS:
FAX:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: rine' �
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:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
1
STRUCTURES ON PROPERTY: FINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
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CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA: