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2004, 09-28 Permit App: BLD-04-07791 Reroof$61(an'e\'' .0,#Valley V 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: /� 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: