2004, 03-09 Permit App: BLD-04-03730 Pole Bldg crry Or' Nook
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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
REQUIRED SITE INFORMATION
STREET ADDRESS: LAY) i, ).4 e e k,4 ._ gG_211
ASSESSOR'S TAX PARCEL NUMBER(S): 351ay IciO
LEGAL DISCRIPTION:
PERMIT DESCRIPTION D k Y,30' i`Geos4 .e bu:Ids n5_
ratUi DING PERMIT 0 CHANGE IN USE 0 GRADING 0 MANUFACTURED HOME
®-RELOCATION" 0-SIGN DTENANT 0OTHER...
OWNER / APPLICANT INFORMATION`
® OWNER: ('y-eort+' 0 APPLICANT:
PHONE(-0A 5.4 L. 44 FAX: PHONE: FAX:
ADDRESS: kgEb0 E ' PJiLcr.e_ L„)A( 911. 113 ADDRESS:
ITY,STATE,ZIP - CITY,STATE,ZIP
®CONTRACTOR: TOtuv. b.rt. ((,,,KAIy tL 4/ ttS ® ARCHITECT:
PHONE: 5091 Sir`5DI f0 FAX: S N-�8 30 PHONE: FAX:
ADDRESS: 9 ib E, 1/ev f 50..1fo.e�f�� t, 1, qa 111 ADDRESS:
C1TY,.STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# TWWA/a r 1.)3 Up CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: 13`I9.‘` OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: >k '30'1'''(1 CONSTRUCTION TYPE: COSI- F,z..w„e UNFIN BASEMENT:
NUMBER OF STORIES: I STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE: y e
FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: • •
' DECK:
REAR SETBACK: CURRENT SEPTIC USE: 5 ,3 ef"
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
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