2003, 09-26 Permit App: BLD-03-02606 PatioSj ok e"
jValley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING D/V/S/ON
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS' 3(.01A S( BA I t
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: CDU BRED Pf rtc
"SIBUILDING PERMIT 0 CHANGE IN USE 0 GRADING ® MANUFACTURED HOME
®RELOCATION Q SIGN ® TENANT Q OTHER
OWNER / APPLICANT INFORMATION
®OWNER::\,.A,)( (AMk& 1� SM(T1-{ ® APPLICANT:
PHONE:e/ 92Z-07S7FAX: PHONE: FAX:
ADDRESS:3(4 5L DATEy akkPct'CC4t( 97204o, ADDRESS:
CITY, STATE, ZIP
CITY,STATE, ZIP
®CONTRACTOR: ®
ARCHITECT:
FAX: PHONE:
ADDRESS* ADDRESS.
CITY,STATE, ZIP CITY, STATE, ZIP
PHONE:
FAX:
WA ST CONTRACTOR LICENSE #
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
( (I
BUILDING HEIGHT TO PEAK/5 "IO OCCUPANCY GROUP: 2ND FLOOR SQ FT:
30% SLOPES ON PROPERTY:
MAIN FLOOR SO FT:
BUILDING DIMENSIONS:2g\ (.51-716.-f CONSTRUCTION TYPE:
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:
LEFT SETBACK: CURRENT WELL USE:
UNFIN BASEMENT:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
Je
IS PUBLIC SEWER AVAILABLE:
IS PUBLIC WATER AVAILABLE:
® YES ® NO
0
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: YES NO PSSA: 0 YES 0 NO
DATE:
I
® BOLTING ®CONCRETE CI REINFORCEMENT
FIRM NAME:
INSPECTOR(S):
PHONE:
CI WELDING
FAX:
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:
PAINT BOOTH: TENT:
FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
IWA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS: "
CITY, STATE, ZIP -
ISPECIAL INSPECTIONS
1
BUILDING STAFF USE ONLY
1
STAFF:
1
METHOD OF PAYMENT:
®
0
CASH CHECK
VISA
BANKCARD 41; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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APPROVED
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APPROVED BY