2003, 07-26 Permit App: BD-03-855 Reroofoe\40,Valley
,9- es- i3T
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUN/TY DEVELOPMENT
BU/LD/NG DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206 ..
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:
5D� 5. k ore h
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: r�D1= ► n GN r a �.0 . ((R p �--- +CAV Of/1 repML e
IJ CHANGE IN USE 0 GRADING 0 MANUFACTURED HOME
[SIGN Q TENANT
a BUILDING PERMIT
URELOCATION
CI-Ot'ttER
OWNER / APPLICANT INFORMATION
® OWNER: /W. l/./?
PHONE:
FAX:
ADDRESS:
® CONTRACTOR: t �1 •
",,
PHONE: 9'( , '. O (O /
CITY,STATE, ZIP
® APPLICANT:
PHONE:
ADDRESS:
CITY, STATE, ZIP
j ® ARCHITECT:
FAX: PHONE:
FAX:
ADDRESS: /50 Z? -Su t V
WA ST CONTRACTOR LICENSE #
FAX:
t CI)/IPC !,�J , 10» ADDRESS:
CITY, STATE, ZIP Wpqs-- CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 00
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:2/ O�
NUMBER OF STORIES: 1
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK: