2003, 10-31 Permit App: BLD-03-02961 ShopSOUlian'` e\s,
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
STREET ADDRESS:g /Q 9 / I ,, (I l �- 1 /\
ASSESSOR'S TAX PARCEL NUMBER(S): IIISSS^^^ Q�J
LEGAL DISCRIPTION:
PER
DESCRIPTION:
BUILDING PERMIT ® CHANGE IN USE - 0 GRADING
E]RELOCATION 0 -SIGN E ITENANT
® MANUFACTURED HOME
0-0 FILER
OWNER / APPLICANT INFORMATION
_ OWNER:
A/Dp RESS: 0 �L/
Y.Y CONTRACTOR: �i
CITY,STATE, ZIP
PHONE: i 4 n / ';
ADDRESS: 047694 le- Fie ,a.,
/'CIITTYY,,, STAT , ZIP
WA ST CONTRACTOR LICENSE a ( c2'2 L
FAX:
® APPLICANT:
PHONE:
ADDRESS:
0
FAX:
ARCHITECT: c2 kr%
PHONE: 4/c-67%-
( S7(FAX: �
ADDRESS OC" 213 asp �p4-T Ci✓e1
CITY, STATE, ZIP
CONTACT: / ✓ 4 (/\
CITY, STATE, ZIP
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 91a29
BUILDING HEIGHT TO PEAK: /S
BUILDING DIMENSIONS: 3OXSC/
NUMBER OF STORIES:
NUMBER of BEDROOMS: -79-
FLANKING
FLANKING SETBACK:
FRONT SETBACK: /90 /
REAR SETBACK: 20
LEFT SETBACK:
3 -
RIGHT SETBACK:
%c
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:"
CONSTRUCTION TYPE:
Posf
STRUCTURES ON PROPERTY: I
CRITICAL AREAS: "
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
Kees
CURRENT SEPTIC USE: 17-e>
CURRENT WELL USE: @ t{ -y
IMPERVIOUS SURFACE AREA:
MAIN FLOOR S0 FT:
2N0 FLOOR SO FT:
UNFIN BASEMENT:
FINISHED BASEMENT::
GARAGE:
COVERED DICK:
DECK: �-
1
MANUFACTURED HOME
WIDTH:
YEAR:
MANUFACTURER:
LE ' GTH:
ET:
SIGN
SQFTO SIGN. HEIGHT OF SIGN: •
#OF SI
TYPE OF SI
AREA OF EXIST SIGN:
RELOCATION
FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE "SPRINKL
PAINT BO
FIREWO
FIRE ALARM:
BLASTING:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER:
ADDRESS:
NT:
DATE/TIME:
PHONE: FAX:
INSPECTOR:
ADDRESS:
CITY, STATE, ZIP
PHONE: FAX:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING ®CONCRETE / : ® REINFORCEMENT ❑ WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWERAVAILABLE: CI YES ® NO IF YES: 0 COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: 0 YES ® NO 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 ❑ NO PSSA: 0 YES 9 NO
DATE:
METHOD OF PAYMENT:
1
STAFF:
O ❑
CASH CHECK
BANKCARD1 EXPIRES: VIN#
AUTHOR/ZED SIGNATURE:
`FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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