2004, 05-04 Permit App: BLD-04-04262 Pole BldgSpokane
#00Valley
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: 1 I 0? Al •
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: x ,ts5 t+o P C tPotz 1`3uf,a>`^fa
($ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation
❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: _eke tSLks Kea ❑ Applicant:
Phone: a36 -teya4 Fax: Phone: -
Address: a•7$1q f, frk,c r. -ry Address:
nc/
ity I State
WA- 9966? Zip Code City State Zip Code
❑ Contractor: d 0 -Wei< /5'n' IL-- ❑ Architect:
Phone: 1/V7 4j696 Fax: Phone: Fax:
Address: 129' C, ALI%rTf1—.
e7Address:
�nA'wn 004 99'7_67
City State Zip Code
Fax:
WA State Contractor License #:
City
Contact:
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:C7 Fr
DIMENSIONS: X
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2"" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
POO 4,7 Pr
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL' HABITABLE SPACE:
IMPERVIOUS SURFACEAREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
ADDRESS 10'
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FRONT3I �� LINKING
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Qote: �� ` s,
05/04/2004 15:32
Since our office does
following information
Project address:
5093241567 SRHD EHS
SPOKANE REGIONAL HEALTH DISTRICT
Environmental Health Division
1101 W College, Rrn 402, Spokane WA 19201 (509) 324-1560
PAGE 01
SEWAGE SYSTEM VERIFICATION FORM
not have information on file showing the location and size of your system, please provide the
in order for us to review your proposal.
I •igN bo//q •, g/ " —7)06
Phone:
15 A) M4P6 023 -479
Property owner: Address:
f S£ -t5 k &Lee cZ1
Existing property use: 64 residential 1
If a business, name and nature:
4
If a business, approximate metered water consumption: _
Type of wastewater fixtures connected to sewage system(s):
toilets showers/tub
car wash sprinkler system _
dishwasher
Year structure built: 11;5 Year sewage system installed:
Number of bedrooms:
Has existing sewage system(s) been reconstructed or repaired? ( ) Yes "S:i0o
If yes, when: Reason:
Location and size of the system: Please make or submit a drawing showing location, dimensions, and measurements of your lot,
structure, sewage system(s), water wells, waterline, driveways, direction `north", etc. IDENTIFY WHAT IS DRAWN.
( ) multi -family
;gallons per
sinks laundry
hot tub/spa _swimming pool
i 4 3s" (s'ss?' ° / D
fkrrr G rf eh 5' ire- /cG i4^J
I yrt that this inforrmatto It tote best of my knowledge. j
11
Si nature of the property wner
01/99
MAY 04 2004 16:31
date
5093241567 PRGE.01