2003, 08-01 Permit App: BLD-03-02205 Reroof��cane\
40,0Valley
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
STREET ADDRESS: `\. \ 5
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
UILDING PERMIT . DCHANGE IN USE -a GRADING
LOCATION 1 SIGN O -TENANT
a MANUFACTURED HOME
�] OTHER
OWNER / APPLICANT INFORMATION
® OWNER: \NN
' \ e �Q l� av ® APPLICANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: \\ \ \-X\ \lk..-(i\ .
ITY,STATE, ZIP
® CONTRACTOR: -- ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,. STATE, ZIP
ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT f
�� cS 0�9.Qn
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE:
FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: DECK:
REAR SETBACK: CURRENT SEPTIC USE:
30% SLOPES ON PROPERTY:
MAIN FLOOR SQ FT:
OCCUPANCY GROUP: 2N0 FLOOR SQ FT:
CONSTRUCTION TYPE: UNFIN BASEMENT:
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA: