2004, 03-11 Permit App: BLD-04-03744 Pole Bldg ls.,. c
SpoTyikane
0 MilkY
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIV/S/ON
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone:(509)688-0036 Fax:(509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: 5 . 35- / ("Jooc) biQ f J
ASSESSOR'S TAX PARCEL NUMBER(S): `/S 3 3 ) ,2 3 t 3
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: 32 X Lf C)
;fBU1LDING PERMIT aCHANGE IN USE 0 GRADING a MANUFACTURED HOME
}RELOCATION ®-SIGN 0 TENANT 0OTTIER-
OWNER / APPLICANT INFORMATION
° OWNER: iq )ct v , i S Q K APPLICANT: 1,i- (—
PHONE:
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PHONE: 922- y 2 C\y FAX: ----- PHONE: FAX:
ADDRESS:_ 3S2I u.9otlot,iti yoLoike 99206 ADDRESS:
CITY,STATE,ZIP - CITY,STATE,ZIP
®CONTRACTOR: Ta iii n d-Lc,LA-49 1 c,c{ I CS c✓S . ® ARCHITECT.:
PHONE: (505) S-35'-1/3 7 4 FAX: 53 Si- 2 8'3 O PHONE: FAX:
ADDRESS: _5-9/f . E T✓t'i+ Spo. OA, 992i ADDRESS:
CITY,.STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE#TdW h G.31 12 3 C.. CONTACT:
PERMi'i'/BUiLOtNG INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: /2-1(0
BUILDING HEIGHT TO PEAK: if: (..." OCCUPANCY GROUP: [� t 2ND FLOOR SQ FT:-
BUILDING DIMENSIONS: 3,2-)t (*) CONSTRUCTION TYPE: Post Frew, UNFIN BASEMENT:
NUMBER OF STORIES: i 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: S2 w t ✓
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
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APPROVED BY .t i. /1 //`'
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