2004, 03-11 Permit App: BLD-04-03737 MH •
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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
I REQUIRED SITE INFORMATION
'STREET ADDRESS: 44/2 At s;.-t/O'4 4, ..5-T, ?
ASSESSOR'S TAX PARCEL NUMBER(S): /1S15 3. 6�( 39-
LEGAL DISCRIPTION: SB C3 ( 6
PERMIT DESCRIPTION: t ���2lfX_%L G/�.�•tt er-4-uiJn{i
- BUILDING PERMIT 0 CHANGE IN USE a GRADING
MANUFACTURED HOME
OREI;UE'ATION fp SIGN 0 TENANT g]OTHER
OWNER / APPLICANT INFORMATION
® OWNER: e>L1.(C,., (--I--S k.,- 2.„../v`�� I d APPLICANT: f,/0
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PHONE: FAX:J PHONE: 1.2 B-,34%03 FAX:
ADDRESS: ADDRESS: 1..f / E. .SRE'ottos14d40,4-2,E R4
CITY,STATE,ZIP CITY,STATE,ZIP
®CONTRACTOR: CUIr f,m aku k, - ® ARCHITECT:
PHONE:
FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE#/MS/LC/D93O& _ CONTACT:
I PERMIT/BUILDING INFORMATION
1
COST OF PROJECT: 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: I I� OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: g'`I X CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE:
FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: DECK:
REAR SETBACK: CURRENT SEPTIC USE: IA4 t liv\cc t-1 x Li
LEFT SETBACK: CURRENT WELL USE:
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RIGHT SETBACK: IMPERVIOUS SURFACE AREA: C
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