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2004, 03-17 Permit App: BLD-04-03794 Pole BldgS`�e®" .Palley PERMIT APPLICATION WORK SHEET SPOKANE VALLEY COMMUN/TYDEVELOPMENT 6U/LD/NG D/V/S/ON 11707 East Sprague Ave Ste 106 Spokane Valley, WA 99206. . Phone: (509)688-0036 Fax: (509)688-0037 REQUIRED SITE INFORMATION 1 1 , STREET ADDRESS: no l AltAkikvtu ASSESSOR'S TAX PARCEL NUMBER(S): 1 s- Op r° LEGAL DISCRIPTION: �/�,,�7 ^�__��-.. 1. �f'S4.O8SO PERMIT DESCRIPTION: .i, BUILDINGPERMTT ®-GRANGE IN USE O GRADJNG DRELOCATION 13 -SIGN 13 -TENANT O MANUFACTURED ROME OWNER / APPLICANT INFORMATION ar OWNER: (TIM 0§1 PHONE: %t 241% y��FAX: y� .�1 �• - ADDRESS: I en S. i 4p2.' J ae. 0} .�-',A � & /E PCITY,STAT - ''LJ/I CONTRACTOR: 1&91W37iL 8tJEz4En O APPLICANT: Sii/K€ 115 OW11e2 PHONE: ADDRESS: FAX: ����((ARCHITECT: PHONE:��1011#, FAX: 57''�// -Mo PHONE: 9 ADDRESS: I r e. TREAT 1/!0 p ,1C, 14 ADDRESS: CITY, STATE, ZIP FAX: CITY, STATE, ZIP WA ST CONTRACTOR LICENSE # 70EUNC17X 123 fo CONTACT: PERMIT/BUILDING INFORMATION COST OF PROJECT:if 12.02 -5 - BUILDING HEIGHT TO PEAK: I? I / BUILDING DIMENSIONS: 32 1 X'fr NUMBER OF STORIES: 1 NUMBER of BEDROOMS: 0" FLANKING SETBACK: FRONT SETBACK: REAR SETBACK: LEFT SETBACK: 30% SLOPES ON PROPERTY: O 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: 1440 2ND FLOOR SQ FT:- UNFIN BASEMENT: FINISHED BASEMENT: GARAGE: COVERED DECK: DECK: 3)m FIQA5o4 17o7_ 5. mArYtg7L- ADDRESS I La lNl( CA VCS(_ ZONE idle 3 .s_ _ ROAD WIDTH FRONT Sd-1 F COMMENTS REVIEWED BY 315 stfa) This site plan is bei ng submitted for the pur g a building permitslid is POee or riTiesentation of Pf0posai. Alt kno the a true wn n const} proporty 10 -,,s. stub hd • , been idem) • � structures Md e bodies of water 0 indicated are we or other critical antes' Signed: Date: µ015 E 7 )C = ArtEtM L Mop ►ht5c LAnt5'* �tdkYVLE� 57 l,v RCCE55 -to 51 rF $ C- 55 t u1A/