2004, 04-01 Permit App: BLD-04-03954 ShopSPiane -
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Va//ey, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
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STREET ADDRESS:
79/7 Z' , 16t/o
ASSESSOR'S TAX PARCEL NUMBER(S):
�! ..co 73, GiV3
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: 2 /,4�� .� Sierra -4,v a �/X 3� A C 5",
II DING PERMIT CI -CHANGE IN USE a GRADING $a MANUFACTURED HOME
}SIGN UTENANT
URELOCATION •
Q-OF1tER
OWNER / APPLICANT INFORMATION
® OWNER: Co /CO4A' L7 G 49/1-e C
PHONE: -- 7 y 74/ FAX:
ADDRESS: 7 7 E, iet/p
CITY,STATE, ZIP
°CONTRACTOR: /9a//11g (1,24
K/ 4 . .
j
PHONE .53s�'�O'7� FAX: 53 Ll ' 3O
ADDRESS: 5'9/ ,?Tkr-4.".74-e.
S vic.9� t
le.//4 q9 4:z CITY, STATE, ZIP
WA ST CONTRACTOR UCENSE # 704/A/!'/5'2. /23 c (�
® APPLICANT:
PHONE: FAX.
ADDRESS:
CITY, STATE, ZIP
ARCHITECT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: // 700, ci 30% SLOPES ON PROPERTY:
i/
BUILDING HEIGHT TO PEAK: /G-1-6 OCCUPANCY GROUP:.
BUILDING DIMENSIONS:42'/X3t CONSTRUCTION TYPE:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE: 7% X /GO
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT: 5‘ V
2N0 FLOOR SQ FT:- "''9
UNFIN BASEMENT: / V A.
FINISHED BASEMENT://A
GARAGE:
COVERED DECK:
DECK:
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"EV EW BY
This site plan Is being submitted for the purpose of
obtaining a building permit and is a true and correct
Spresentation of the proposal. All known property
ines/dimensions, cu • roes, structure- and easements
have been ident ' _ Also in • are wetlands,
bodies of wat - p _ o • other critical areas.
Signed* _.
Date' 54 L
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