2003, 07-09 Permit App: BD-03-761 MHi
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:
It) 00
ASSESSOR'S TAX PARCEL NUMBER(S): ,1 .5"G % 3 / // ,
LEGAL DISCRIPTION: 5-u �l /
PERMIT DESCRIPTION: / / -9 es u",/
i os A? r (V / ' 1/1/ 5_ k:6e /TJ
BUILDING PERMIT ® CHANGE IN USE 0 GRADING
QRELOCATION
® SIGN El TENANT
'1:itNTUFACTURED HOME
E OTHER
OWNER / APPLICANT INFORMATION
® OWNER: Pa 171 /0 /a. O i� t
PHONE: C(- S / a -/4, 3? FAX:
ADDRESS: "5./ 9 e Kan {1 e
CONTRACTOR:
PHONE:
ADDRESS:
CITY, STATE, ZIP
CITY,STATE, ZIP
FAX:
WA ST CONTRACTOR LICENSE #
® APPLICANT: 74/7 y F) (° ) y C� / e 7
PHONE: 7 20 / S / a FAX: ��/� " 5- _4 S
ADDRESS: 7,7 / �V i7e S `2d �! -zo
®
5/2) ICa i? e kiGt CITY, STATE, ZIP
ARCHITECT:
PHONE:
FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT /BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK:
1
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER:
PAINT BOOTH:
FIREWORKS DISPLAY:
BLASTING:
FIRE ALARM:
TENT:
DATE /TIME:
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN: HEIGHT OF SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
RELOCATION
FIRE SAFETY
1
WA STATE NON - RESIDENTIAL ENERGY CODE
PLANS EXAMINER:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING ®CONCRETE ® REINFORCEMENT
FIRM NAME:
INSPECTOR(S):
PHONE:
® WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO
0
IS PUBLIC WATER AVAILABLE: YES NO
IF YES: COUNTY CITY
IF YES, WHICH WATER DIST /IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES NO PSSA: ® YES ® NO
DATE:
STAFF:
METHOD OF PAYMENT:
CASH CHECK
VISA
BANKCARD 1f • EXPIRES: VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD