2003, 10-14 Permit Application Worksheet: Addition over GarageCffY
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUN/TY DEVELOPMENT
BUILDING DIVISION
1 1707 East Sprague Ave Ste 106
Spokane Valley, WA 99206...
Phone: (509)688 -0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: -$ / 8 2 J /9da m. S
el cc /� �Q: yyo j 7
ASSESSOR'S TAX PARCEL NUMBERS):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION.: /�% „ %z� p +7 • 4 70--
Ei BUILDING PERMIT - • EI.CHANGE IN USE .a.GR.ADING O.MANUFACTURED .HO/VIE
- RELOCATION ®-SIGN Q TENANT DOTTER
OWNER / APPLICANT INFORMATION
® QWNER: yA /-e.•-•-) i
tce. /S A
/
PHONE: k-,5 6 *Z. FAX:
ADDRESS: 5, /e2/ i�%d, ,-, V y
® CONTRACTOR: S am-4
PHONE:
ADDRESS:
s
s / rJr.�
CITY,STATE, ZIP
FAX:
CITY, . STATE, ZIP
WA ST CONTRACTOR LICENSE #
® APPLICANT:
PHONE: FAX:
q'r 3'7
ADDRESS:
CITY, STATE, ZIP
ARCHITECT:
PHONE:
ADDRESS:
CONTACT:
FAX:
CITY, STATE, ZIP
PERMIT /BUILDING INFORMATION
COST OF PROJECT: G' 0
BUILDING HEIGHT TO PEAK: -2o Fr
BUILDING DIMENSIONS:v7 Y X' D
NUMBER OF STORIES: <
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK: -5-0
REAR SETBACK: n
LEFT SETBACK: 2
RIGHT SETBACK: 02 Li
30% SLOPES ON PROPERTY:
MAIN FLOOR SQ FT:
OCCUPANCY GROUP: 2ND FLOOR SQ FT:- C 72
CONSTRUCTION TYPE: UNFIN BASEMENT: /•
STRUCTURES ON PROPERTY: FINISHED BASEMENT: /"
CRITICAL AREAS: GARAGE:
CURRENT PROPERTY SIZE: /a/ X((,/ COVERED DECK: /v •
CURRENT PROPERTY USE: /, ,'n z= DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
WA STATE NON - RESIDENTIAL ENERGY CODE I
1
1
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN: HEIGHT OI SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
RELOCATION
FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
FIREWORKS DISPLAY:
BLASTING: DATE /TIME:
PLANS EXAMINER:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING
FIRM NAME:
INSPECTOR(S):
®CONCRETE
® REINFORCEMENT
PHONE:
® WELDING
FAX:
BUILDING STAFF USE ONLY
1
;1f
IS PUBLIC SEWER AVAILABLE: YES ® NO
IS PUBLIC WATER AVAILABLE: YES ® NO IF YES, WHICH WATER DIST /IRR:
IF YES: COUNTY CITY
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ® YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: 0 YES 0 NO
DATE:
METHOD OF PAYMENT:
CASH CHECK
BANKCARD // EXPIRES; VIN#
AUTHOR /ZED SIGNATURE:
STAFF:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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