2003, 09-11 Permit App: BLD-03-02440 Sidingt.
S
alley PERMIT APPLICATION WORK SHEET
SPOKANE VALLEYCOMMUN/TYDEVELOPMENT
BU/LD/NG DIVISION
9 9707 East Sprague A ve Ste 906
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax (509)688-0037
REQUIRED SITE INFORMATION 11
STREET ADDRESS: L HCl 4 � tdlv
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
$UII,m% PE+ RmrT CHANGE IN USE CI.GRADING E3 MANUFACTURED HONE
®RELOCATION .. DSIGN ®-TENANT ®-OTHER
OWNER /APPLICANT INFORMATION
OWNER: G/(/() C[ �S7
PHONE:-)/Z�'�C.Zo3� .{FLAX:
ADDRESS: _/ U! I q ( r 10 L /U It/
CITY,STATE, ZIP
® APPLICANT: l r
,PHONE: / Z2 - Cl '111 I A FAX:
ADDRESS: 77/ r 7 / % Gt/� ti'' ' �' �, Our '✓/7
/J/J �" �f CITY, STATE, ZIP c'�2
®CONTRAC�'T�jO(R: �` � " � • �J / Gt 0 y q G ® ARCHITECT:
�"-�2,2--79i 1 rwr. C II / % /'1 Sf0 PHONE: FAX:
PHONE: �A i �j Gfp
ADDRESS: :22(%J E /"�a�0I�� 5 0 4"L- 14'-A!7212 ADDRESS:
CITY,.STATE, ZIP CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE M Sid % 7 Z L S CONTACT:
COST OF PROJECT: a S0_z�
BUILDING HEIGHT TO PEAK:-,
BUILDING DIMENSIONS:
PERMIT/BUILDING INFORMATION
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE
NUMBER OF STORIES: STRUCTURES ON PROPERTY:
NUMBER of BEDROOMS: CRITICAL AREAS:
DATE: STAFF:-
METHOD
TAFF:METHOD OF PA YMENT.-
E3 91 E3 13.
a. e... lcii�i
'VISA
CASH CHECK _
BANKCARD
AUTHOR/ZED S/GNA
EXPIRES.- V/N#
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE: