2004, 05-24 Permit App: BLD-04-04419 Addition 04, Li-.-) 6,7677sPiane 11,
.000,"""'eY PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION ��
11707 East Sprague Ave Ste 106 liArl
Spokane Valley, WA 99206
Phone: 509 688-0036 Fax: 509 688-0037
REQUIRED SITE INFORMATION ,-
STREET ADDRESS: /7 / 2 L �7 e6
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ASSESSOR'S TAX PARCEL M ER(S): '.- 51"1 (2 ' A )(�")
LEGAL DISCRIPTION:(7I6• v J
PER DESCRIPTION:
UILDING PERMIT ("1 CHANGE IN USE (]GRADING 0 MANUFACTUR:.D HOME
0 RELOCATION U SIGN 0 TENANT (}OTHER
11 OWNER / APPLICANT INFORMATION I
Q OWNER: 0 APPLICANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
I ' • CITY,ST• E,ZIP CITY,STATE,ZIP
®CONTRACTO'> > L4i d 1' 4 ® ARCHITECT:
PHON . /I. - Kt 1 i A .40 PHONE: FAX:
I
ADDRESS: Lim. /4i./lrf ADDRESS:
eth ,.STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR UCENSE# 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:
FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: DECK: —
REAR SETBACK: CURRENT SEPTIC USE: -rC'W1'
. kb,e -11-14:2-
LEFT SETBACK: CURRENT WELL USE: ifr'crr J ,�/�
- It �(7`(-1G(
RIGHT SETBACK: IMPERVIOUS SURFACE AREA: --%� l i,4 ____