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
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1
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STREET ADDRESS:
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ASSESSOR'S TAX PARCEL NUMBER(S): 1 s- Op r°
LEGAL DISCRIPTION: �/�,,�7 ^�__��-..
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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:
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ADDRESS: I en S. i 4p2.' J ae. 0}
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''LJ/I CONTRACTOR: 1&91W37iL 8tJEz4En
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APPLICANT: Sii/K€ 115 OW11e2
PHONE:
ADDRESS:
FAX:
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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
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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:
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