2003, 09-05 Permit App: BLD-03-02402 MHPERMIT 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:
e'sg,e 4 -re--
.
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL. DISCRIPTION:
PERMIT DESCRIPTION: jlipore
OHM:WING PERMIT•
QRELOCATION
. . .
• C1CHANG E.IN.USE -El-GRADING
D -SIGN• 0 -TENANT
ACTURED HOME
THER
OWNER/ APP
ICANT INFORMATION
CI OWNEW
PHONE: FAX:
ADDRESS: /LS • .57,09, "
CITY,STATE, ZIP
r.
CONTRACTOR;
PHONE: 91-ef'-‘74'41--r
ADDRESS: /S. er •
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
0 APPLICANT:
PHONE:
ADDRESS:
FAX:
CITY, STATE, ZIP
ARCHITECT:
FAX: PHONE: FAX:
ADDRESS:
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: /2-577
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS: 2.Crx e
NUMBER OF STORIES: /
NUMBER of BEDROOMS: 3
FLANKING SETBACK: /
FRONT SETBACK: _70
REAR SETBACK: '
LEFT SETBACK: / /
RIGHT SETBACK: /
30% SLOPES ON PROPERTY: /1/.°' /4""6--e.
OCCUPANCY GROUP; clre's ""fr/'•
V,00,4p,•."
CONSTRUCTION TYPE: "4104 ie. A
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
AREAS: --
CURRENT PROPERTY SIZE:e/ X /99
CURRENT PROPERTY USE: /Pe.:5'-'44,1.•
CURRENT SEPTIC USE:„5...efihr*
CURRENT WELL USE:e7freha.-elrelegr
IMPERVIOUS SURFACE AREA:
CITY, STATE, ZIP
y7e,-y C23
MAIN FLOOR SQ
2N0 FLOOR SQ FT: r4-'044
UNFIN BASEMENT:
FINISHED BASEMENT: e"*" -Ai
GARAGE: X
COVERED DECK:
DECK:
MANUFACTURED HOME SIGN
WIDTH: �‘-." LENGTH: 4' C
YEAR: J""de''''t PIT SET: t S
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:
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 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES A NO IF YES: 0 COUNTY 0 CITY "
IS PUBLIC WATER AVAILABLE: YES ® NO IF. YES, WHICH WATER DIST/IRR: 6;l/40k .`,4V "11 -‘/J -----
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
DATE:
STAFF:
METHOD OF PAYMENT:
/0
CASH CHECK
BANKCARD #; EXPIRES: VIN #
AUTHORIZED SIGNATURE:
WSA
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
1
en,- L 7 :,
This site plan is being submitted for the purpose of
obtaining a building permit and is a true and correct
representation of the proposal. All known property
lines/dimensions, curb lines, structures and easements
have been identified. Also indicated are wetlands,
bodies of water, steep s ores or other critical areas.
Signed•
Date' a' 11 -
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