2004, 09-28 Permit App: BLD-04-07791 Reroof$61(an'e\''
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING D/V/S/ON
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: 1509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: 36:2/ -
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: ,eK,2pOf
CI BUILDING PERMIT • C CHANGE IN USE CI GRADING CI MANUFACTURED HOME
CI -OTHER
}RELOCATION
0 -SIGN • CITENANT
OWNER / APPLICANT INFORMATION
CI OWNER:/��ii+-'��� 7 ', 7 " Ij' Z ® APPLICANT:
PHONE: 9 ' 92 ' 6 FAX: PHONE: FAX:
ADDRESS: ' 2� S. 'd S/D�,6,- �,;IXDDRESS:
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CITY,STATE, ZIP
CI CONTRACTOR: I/ 7-71,€. rr �1,7o* rr %.•—c ARCHITECT:
CITY, STATE, ZIP
PHONE: %,/— 72 9 9' FAX: %ZPHONE:
ADDRESS: /3/5:. �✓ i iC/���O.�T%1 �T>
S%D`L}�v livg �'yy ais- CITY, .STATE, ZIP
WA S r t.WNTRA-CTOR LI-CENS
FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
COST OF PROJECT:2700
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
NUMBER OF STORIES: STRUCTURES ON PROPERTY:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
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:
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA: