2003, 12-17 Permit App: BLD-03-03291 Patio CoverSOlane
„000Valley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BU/LD/NG DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:
/49 l 1V bDP( L • 40-/- g- 10
ASSESSOR'S TAX PARCEL NUMBER(S):
575-e)85 . qt)
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:L0
; DUILDING PERMIT CI CHANGE IN USE C GRADING
Q SIGN ® TENANT
QRELOCATION
E OTHER
L
OWNER / APPLICANT INFORMATION
®OWNER:
® APPLICANT:
PHONE: FAX: PHONE:
ADDRESS:
apiref:L) j.41-41,5 caYSTATE ZIP CITY, STATE, ZIP
`6Lb
4CTOCONTRACTTOR: Tt-t VVt7%LJ:
PHONE: S CU, ?-*O FAX: 44;7-'775- `
PHONE:
ADDRESS: /1/) N t1OTC+')5 L
4-17/ig ?-vaiAzip,
FAX:
ADDRESS: L" 1 Ate - ATE,
'2
Z (CITY, ATE, ZIP
WA ST CONTRACTOR LICENSE #
FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: Z C aD- O)
BUILDING HEIGHT TO PEAKK:,
BUILDING DIMENSIONS: /./X i'2
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK: q
FRONT SETBACK: 4/O
REAR SETBACK:
LEFT SETBACK: 3
RIGHT SETBACK:
7O
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE: 11-4.I34Y\
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:
-1\
MANUFACTURED HOME 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: FIRE ALARM:
PAINT BOOTH: TENT:
FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
-110
PLANS EXAMINER:
ADDRESS:
PHONE: FAX:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING
FIRM NAME:
INSPECTOR(S):
® CONCRETE
® REINFORCEMENT
PHONE:
® WELDING
FAX:
BUILDING STAFF USE ONLY
i
.41 IL
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO
IS PUBLIC WATER AVAILABLE: 0 YES 0 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 0 NO
IF YES: COUNTY ®CITY
1
DATE:
jSTAFF:
1
METHOD OF PAYMENT,
CASH CHECK
WSA
BANKCARD #; EXP/RES: VIN#
AUTHORIZED SIGNATURE*
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
4LP1.NE...MOM.E PRODUCTS
9360 N. MARKET
SPOKANE, WA......59217......,
(5Q9) 467-060d
FAX: 467-7751 • alpineonline.iiet
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