2004, 08-24 Permit App: BLD-04-07438 Pole Bldg BUILDING PERMIT APPLICATION WORKSHEET
C1TYt - - - City of Spokane Valley Community Development Department
3poNane Building Division
11707 E. Sprague Avenue Suite 106
400,
'aley Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: 1 10fE \y )/ e-( ac
Assessor's Tax Parcel Number(s):
Legal Description: L i
PERMIT DESCRIPTION: 6 k So'
16 ` �e5le , l hc- SL‘.p
Building Permit ❑ Change in Use (1 Grading ❑ Manufactured Home
n Relocation ❑ Tenant Improvement (1 Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: 6ivti07 Vas„ itov4e ❑ Applicant: 4c, tc. Jr--
Phone: 647 p'J Fax: Phone: Fax:
Address: le- ZDV E- -v Ute_ y Address:
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Ci State Zip Code City State Zip Code
n Contractor: Ger) k: -TOG. n Architect:
Phone:zce-7-4/-ar-6. Fax: - Phone: Fax:
Address: 7E0 til.C_,tc;2 Address:
INFf Pa I,1p6 d'0 Szi
City Y State Zip Code City State Zip Code
WA State Contractor License#: Contact: j e 7 L4,i - ( 9a, gi. - /`I L
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: € DIMENSIONS: #OF STORIES:
-Z2 (o Ac SU/ I
MAIN FLOOR TO SQ. FTG: 2N-)FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FIG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
-- C&G) +91'
OCCUPANCY G.BOUP: COI STV CRO Pf Ems: HEAT SOURCE:
#OF BEDROOMS: TOTAL HABITABLE SPIKE: IMPERVIOUS SURFACE AREA:
'="4:59-_
COST OF PROJECT: 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
19,e SYSTEM? .—
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash (heck 0 Mastercard ❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature:
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044 AGM This site plan is being submitted for the purpose of
obtaining a building psramtl`and is a true and correct
' representation of the propose. AN known property
lines/dimensions,curb Nets.stmetams and aaIMnMfs
have been identified. Also ktdlc*d are wetlands.
bodies of ifietesp el / s or atter ended area.
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