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2003, 10-16 Permit App: BLD-03-02796 MHON U�.'.np 4;00 Va-lifley PERMIT APPLICATION WORK SHEET SPOKANE VALLEY COMMUN/TYDEVELOPMENT BUILDINGDIVISION 1170 7 East Sprague A ve Ste 906 Spokane Valley, WA 99206. Phone: (509)688-0036 Fax. (509)688-0037 REQUIRED SITE INFORMATION STREET ADDRESS: ld / Vl ASSESSOR'S TAX PARCEL NUMBER(S): �.� �_� Q1,03 LEGAL DISCRIPTI PERMET DESCRIPTION: BUILDING PERMIT' CI CHANGE IN USE GRADING1VIAI�TUFACTURED HOME RELOCATION [}SIGN [ TENANT OWNER OWNER /APPLICANT INFORMATION ® OWNER: �q.. -.._%" aZe e ® APPLICA FAX: PHONE: FAX: ADDRESS: 4!5' / � ADDRESS: ® ,�CIT.,STATE, ZIP CITY, STATE, ZIP CONTRACTOR: v t� 13 ARCHITECT.: PHONE: FAX: PHONE: FAX: ADDRESS: CITY,. STATE, ,ZIP WA ST CONTRACTOR LICENSE COST OF PROJECT: BUILDING HEIGHT TO PEAK: BUILDING DIMENSIONS: NUMBER OF STORIES: NUMBER Of BEDROOMS: FLANKING SETBACK: FRONT SETBACK: REAR SETBACK: LEFT SETBACK: RIGHT SETBACK: ADDRESS: CITY, STATE, ZIP CONT PERMIT/BUILDING INFORMATION 30% SLOPES ON PROPERTY: OCCUPANCY GROUP:_ CONSTRUCTION TYPE: STRUCTURES ON PROPERTY: CRITICAL AREAS: CURRENT: PROPERTY SIZE: CURRENT PROPERTY USE: CURRENT SEPTIC USE: CURRENT WELL USE: IMPERVIOUS SURFACE AREA: MAIN FLOOR SQ FT: 2ND FLOOR SQ FT:- UNFIN BASEMENT: FINISHED BASEMENT: GARAGE: COVERED DECK: DECK: MANUFACTURED HOME SIGN WIDTH: / _LENGTH: / SQ FT OF SIGN: HEIGHT OF SIGN: YEAR:PIT SET: # OF SIGNS: AREA OF EXIST SIGN: MANUFACTURER: / Il � 5-A Lt ? TYPE OF SIGN: RELOCATION FIRE SAFETY PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM: PAINT BOOTH: TENT: PROPOSED USE: � FIREWORKS DISPLAY: BLASTING: DATE/TIME: N WA STATE NON-RESIDENTIAL ENERGY CODE II PLANS EXAMINER: PHONE: FAX: ADDRESS: . CITY, STATE, ZIP INSPECTOR: PHONE: FAX: ADDRESS: SPECIAL INSPECTIONS ® BOLTING FIRM NAME: INSPECTOR ®CONCRETE ® REINFORCEMENT PHONE: CITY, STATE, ZIP ® WELDING FAX: BUILDING STAFF USE ONLY 0 E3 IS PUBLIC SEWER AVAILABLE: . YES ® NO IF YES: ® COUNTY CITY IS PUBLIC WATER AVAILABLE: ® YES .® NO IF YES, WHICH WATER DIST/IRR: IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ® YES ® NO IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: ® YES ® NO DATE: STAFF: METHOD OF PA YMENT.- 13 13 13 13 M4 CASH CHECK Iml BANKCARD #; EXPIRES: VIN # AUTHORIZED SIGNATURE. *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD weer as name .first name __. Day time phone Date f -� f l > ,•',-S r t ....... ............................................... Wood Stove (if applicable) ............................... Address } .....:! ....---------.:::.'........ ♦f j } -----.. ........----.......---..... .---------..... .City State Z IP Gas Decorative Appliance (if applicable). Range: changing from gas to electric Electric Water Heater replacement Installer/Contractor/Dealer Electric Water Heater replacing Gas Water Heater P Sone Contractors registration number Z Replace main electrical (ian"el j ' ( ) Low Voltage Fire/Ifi"-!Slori'Aldrr�n Fire Safety; .Addreaa..............................................................................................................................Clry .................................._..................................Stair.........-ZIP+4 ............................ Z 06 W Z ti Serial Number(s) 1 HUD Number(s) (lace fee amount in proper box Mechanical Heat Pump Air Conditioning Furnace Installation (gas or electric) Gas Piping al a Wood Stove ---- Pellet Stove ---- Gas Room Heater Gas Decorative Appliance Range: changing from electric to gas Gas Water Heater replacement Water Heater: changing from electric to gas Plumbing Fire sprinkler system (also requires a plan review) Each added, fixture Replacement of water piping system Place fee amount in proper box Structural [___4 Inspection as part of a mechanical installation (cut truss/floor joist, sheet rocking) Reroofs (may require a plan review) E-3 Changes to home when additions bear loads on home per the design of a professional (also requires a plan review) E Other structural changes (may require a plan review) ° Fire Safety Electrical Heat pump Air Conditioner Furnace Installation (gas or electric) Wood Stove (if applicable) Pellet Stove (if applicable) Gas Room Heater Gas Decorative Appliance (if applicable). Range: changing from gas to electric Electric Water Heater replacement Electric Water Heater replacing Gas Water Heater Each added or modified circuit Hot Tub or Spa (power from home.p)ectr Z Replace main electrical (ian"el j ' O_ W Low Voltage Fire/Ifi"-!Slori'Aldrr�n Fire Safety; W rc t' Z 06 W Z Miscellaneous Plan review Reinspection - - - - Insignia :r Other Note: This permit expires one year after date of purchase. (Non-refundable) ]Work is completed at this time. An inspection is requested. Work is NOT completed at this time, I will call when ready. Q tY 0jLij (I Z NWC 4 J i: NWQ M W a J W l.- Uaa F622-036-000 mfgd/mobile home alteration permit 11-02 White -Olympia Canary -inspector Breen-t_:ontractor rmx-rurcnaser umuenruu-rurcnaser ^440� s �leY APPLICANT: MAILING ADDRESS: CITY: ' PHONE: ( ME) .. DEPARTMENT OF COMMUNITY DEVELOPMENT CURRENT PLANNING ADMINISTRATIVE EXCEPTION APPLICATION AND DETERMINATION PART I TE: 013 (woRx)� in F- 6� 16D d © (CELL) 5Q NOTE: IF APPLICANT IS NOT THE OWNER, INCLUDE WRITTEN OWNER AUTHORIZATION FROM THE LEGAL OWNER BELOW /7 _ /l / o -r-- LEGAL OWNER: MAILING CITY• TE: k-% ZIP: PHONE: (HOME) - (WORK)_J( `!n �_(CELL) 07- 226P- TAX PARCEL NO: 73 DI 1)-3 --STREET ADDRESS OF SITE: C/o LEGAL DESCRIPTION: C✓� D O rz / moi / /L�, n 10 / 2 20 /:7- Q /V ZONING CLASSIFICATION:: K -�� COMPREHENSIVE PLAN CATEGORY: TYPE OF ADMINISTRATIVE EXCEPTION IA - All r -y 0 A If �._� . r� . APPLICABLE SECTIONS) OF ZONING CODE: i q. S06 - O`Rq NOTE: A SITE PLAN AND SUPPORTIVE DOCUMENTS SHALL BE INCLUDED WITH THIS APPLICATION • PART IV DETERMINATION File No: AE ---D-7 The Department of Community Development fmds that the information provided by the applicant and compliance with the City of Spokane Valley Zoning Code and all other development regulations, d s does not adverse affect on the adjacent properties nor the public's general health, safety and welfare. The Department of Community Develop en . approves)ions enies this "Administrative Exemption" as conditioned below, for the property described in Part ursuant to 14.506.000 and 14.506.020 of the Zoning Code. This administrative exception is subject to the following conditions of approval: 1) This administrative decision shall apply to the subject property indefinitely and may be transferred to future property owners, heirs or any successor in interest to the property subject to the conditions of approval contained herein. 2) The applicant and property owner shall comply with all requirements and regulations of the Zoning Code. 3) The applicant shall comply with all applicable development regulations and standards. 4) The applicant and property owner shall comply with the following additional conditions: � / , 20D3 This administrative exception is hereby approved this /� day of L . Ci6 Approved b Title: Q s pP Y� Under Section 14.412.041 of the City Zoning Code, any person aggrieved by this administrative determination has the right to appeal this administrative decision to the City of Spokane Valley Hearing Examiner. An appeal must be filed by submitting the appropriate appeal application together with the required fee to the Department. of Community Development Current Planning, within fourteen (14) calendar days after the decision is issued. Upon receipt of a complete appeal application, a public hearing will be scheduled. For information or questions, please call (509) 921-1000 Rev 6/03 0 Lq N fx� A4E