2003, 07-16 Permit App: BLD-03-02037 New RoofS fiaane
#Malley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILD/NG DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: 2.709 S. Sc.4es ,e StoOk......e, WAr 992-06
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
® BUILDING PERMIT • ® CHANGE IN USE
®RELOCATION
® SIGN
® GRADING
® TENANT
® MANUFACTURED HOME
®OTHER
OWNER / APPLICANT INFORMATION
® OWNER: Y.vfs M; y ^L okofrko✓ ® APPLICANT:
PHONE: 9?.I"'o &2.2 FAX- PHONE: FAX:
ADDRESS: a.%D9 S. $0,•1-1.$ Oaf ADDRESS:
CITY,STATE, ZIP CITY, STATE, ZIP
®CONTRACTOR: ® ARCHITECT:
PHONE: FAX: PHONE:
ADDRESS: ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # CONTACT:
FAX:
CITY, STATE, ZIP
PERMIT/BUILDING INFORMATION
COST OF PROJECT: itiv. V
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: UNFIN BASEMENT:
STRUCTURES ON PROPERTY: FINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
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
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER: FIRE ALARM:
.i\ _ .I . .) \ ri.
PAINT BOOTH: TENT:
FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:`
CITY, STATE, ZIP
i y
SPECIAL INSPECTIONS
® BOLTING
FIRM NAME:
INSPECTOR(S):
°CONCRETE
0 REINFORCEMENT
PHONE:
0 WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO
IS PUBLIC WATER AVAILABLE: ® YES ® NO
IF YES: 0 COUNTY 0 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: 0 YES 0 NO
PSSA: 0 YES 0 NO
METHOD OF PAYMENT:
0
0
CASH CHECK
BANKCARD A;• EXPIRES: V/NAI
AUTHOR/ZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
0
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