2003, 08-25 Permit App: BLD-03-02310 Tear Off, ReroofPTV
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1Valley
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
1\ STREET ADDRESS: 6./2 C - ,IGS,✓ P ,fes 6
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: -7r m/'' /e/{o ?
®BUILDING PERMIT
DRELOCATION
® CHANGE IN USE 0 GRADING 0 MANUFACTURED HOME
Q SIGN Q TENANT
DOTTIER
OWNER / APPLICANT INFORMATION
X ® OWNER:\:74/file f 6 /liar -
CI APPLICANT:
PHONE:, -c07 �i2Z -5-a?7 FAX: PHONE:
ADDRESS: C`J/�'!e
FAX:
ADDRESS:
CITY,STATE, ZIP CITY, STATE, ZIP
®CONTRACTOR: ® ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY, STATE, ZIP
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:_5 O 0 4142
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
3-
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE: UNFIN BASEMENT:
STRUCTURES ON PROPERTY: FINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
COVERED DECK:
DECK:
ANUFACTURED HOME 0 ft 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:
PAINT BOOTH:
FIREWORKS DISPLAY:
BLASTING:
FIRE ALARM:
TENT:
DATE/TIME:
IL WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE:
ADDRESS:
FAX:
INSPECTOR: PHONE:
ADDRESS:
CITY, STATE, ZIP
FAX:
CITY, STATE, ZIP
I V F
SPECIAL INSPECTIONS
BOLTING
FIRM NAME: PHONE:
INSPECTOR(S):
°CONCRETE
REINFORCEMENT
WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 13 YES 13 NO
IS PUBLIC WATER AVAILABLE: 0 YES 0 NO
IF YES: COUNTY
IF YES, WHICH WATER
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA:
13 CITY
DIST/IRR:
0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: YES NO PSSA: Q YES 0 NO
DATE:
STAFF:
METHOD OF PAYMENT:
CASH
CHECK
BANKCARD #;
AUTHORIZED SIGNATURE:
EXP/RES: VIN #
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
Nur- r