2004, 04-12 Permit App: BLD-04-04059 Pool _gijytikantli,e\veli*k
Milley 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: \ 3 0 2-Ls E- ( v` \JizA \ "" c(--`
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
1►' UILDING PERMIT' EI CHANGE IN USE f GRADING CI MANUFACTURED HOME
ii.RELOCATION Et SIGN Q TENANT D OTHER
OWNER / APPLICANT INFORMATION
® OWNER: 7 M?- JVY1 `
� �� WY 1C ® APPLICANT: �V\1� `�`��C' S `
PHONE: 92 -OZ�i 6 FAX: N f� PHONE: `\ ` ` ` R FAX: "�1,1 C1Z
ADDRESS:
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0�t � E- . c JIJ1�`� �a Vei� �I ADDRESS:( i5 E- ,��\ C\ VV I IZ
5t_1,`� ,b
�-�1.�
CITY,STATE,ZIP a` �L TY,STATE,ZIP
®CONTRACTOR:Pa\a.` 1s ' ` ARCHITECT:
PHONE: 14°61- O\C\-\ y �
,
FAX: `-4�1' CO(A2- PHONE: FAX:
ADDRESS: (QC-F0 E• �'\\a\�6 <-�`\5 S AtvV'` c _ ADDRESS:
CI ',STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# .NNE\-C`--0 4L\-\) CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE:
IDATE: I STAFF:
METHOD OF PAYMENT::
4 VISA
CASH CHECK
BANKCARD It; EXPIRES: VIN#
AUTHORIZED SIGNATURE'
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
3G
30
vSe
Z°
This site plan is being submitted for the purpose of
obtaining a building permit and is a true and Correct
representation of the proposal. AN known property
ADDRESS lines/$imensions,curb lines,structures and easements
ZONE have been identified. Also indicated are wetlands,
ROAD WIOTHbodies • stev
slopesor other critical areas.
FRONT
� SigrNd.
COMMENT= e��I�irl'�a�' 7,- � . Oete l L Zl
REVIEWED ( ll(