2003, 10-06 Permit App: BLD-03-02690 MHSpokane
assoValley
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:
/70 C 41 lroL.ih..-
55(383.90rz-
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
4,4
PERMIT DESCRIPTION: $e74
0 BUILDING PERMIT ® CHANGE IN USE 0 GRADING
®RELOCATION
®-SIGN ®TENANT
MANUFACTURED HOME
® OTHER
OWNER / APPLICANT INFORMATION
® OWNER: Tt{df 7)11)1 571Z(/1
PHONE(2)Y) R397FAX:
ADDRESS: 723 ! $, NC wadi Alive/ 9920 3
�L, • CITY,STATE, ZIP
®CONTRACTOR: /k?3$)an.
j., s L / e
PHONE: 753 1,7 3 FAX: 927- 707 S7
ADDRESS: / S9/6 G- %quf e vdln -Cad 9903 7
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
EI
APPLICANT: g(/4 LSfez n!d/SO!/I
PHONE(cay) 953 3923 FAXio('J 27- G75?
ADDRESS: X57'5 ,E Ce,weidh el 7,037
CITY, STATE, ZIP
ARCHITECT: •
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK: /9 (
BUILDING DIMENSIONS: 17 X07
NUMBER OF STORIES: /
NUMBER of BEDROOMS: 3
FLANKING SETBACK: /Z(
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
%1 J0 fo
yl
/9r
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE: UNFIN BASEMENT:
STRUCTURES ON PROPERTY: No,ut. FINISHED BASEMENT:
CRITICAL AREAS: /U/C} GARAGE:
CURRENT PROPERTY SIZE: IDD )( S2 COVERED DECK:
CURRENT PROPERTY USE: VQ e n I DECK:
NQ
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
CURRENT SEPTIC USE:
N�
CURRENT WELL USE: N A-
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
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