2003, 10-13 Permit App: BLD-03-02756 Tear Off, ReroofSpite' ..
Valley
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
1
STREET ADDRESS: W1? 19 C Gait{
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL INSCRIPTION:
PERMIT DESCRIPTION: e,Q
®BUH,DP4G PERMIT
®RELOCATION
0 CHANGE IN USE CI GRADING
Q SIGN Q TENANT
® MANUFACTURED HOME
(OTHER
OWNER / APPLICANT INFORMATION
® OWNER: \V\-- QA1�N•44^041L
PHONE:
FAX.
ADDRESS:
_t ITY,STATE, ZIP
® kkCONTRACTOR:: (\�\ ��'ESp�
PHONE: 91 1' ` c FAX:
\"\
ADDRESS: 2O C- , \yw ,
kif
1 TY, STATE, ZIP
Ili WA ST CONTRACTOR LICENSE Il04OtC.a I i3 UJ
0
APPLICANT:
PHONE:
ADDRESS:
CITY, STATE, ZIP
FAX:
ARCHITECT:
PHONE:
TWO ADDRESS:
FAX:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 1 ( ea
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:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
CURRENT. PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA: