2005, 02-03 Permit App: 05000366 ReroofCfIOM : f1LfIhIC COHCTf1UCTIOhi me. hto. : buueiqutiaug
S
do0OValley
z�ro5
CSS 3(r1„
. PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
• Spokane Valley, WA 99206
.Phone: (609)688-0036 Fax: 509)688-0037
KEQUIK J SITEE4114FUKMA 1 ION
STREET ADDRESS;
�SIZ E Kitt vx
ASSESSOR'S TAX PARCEL NUMBER(SI:
LEGAL DISCRIFTION:
• PERMIT DESCRIPTION:
V DD.TO Kim=
}RELOCATION
C] 4.No73 DI uaD p an.4D1XC
Et SIGN CITENANT
o)l:LNUT.t.crunED IIO�Ii~
OTKEE
OWNER/ APPLICANT INFORMATION
D OWER:
PHONE: FAX:,
CI APPLICANT:
PHONE:
ADDRESS: ADDRESS
OITv crrAT[, Sin
FAX:
r`ITY. STATF 7IP
CONTRACTOR:LP STAA- J C;T-) O sV 1:1‘ ARCHITECT.:
PHONE: '[ - �� q c) FAX '4 1/4Vv ' S S y q PHONE: FAX:
ADDRESS:'*' tq A`�'r Dit SPpatdr 223ADDRESS:
CITY,. STATE, ZIP CITY, STATE, ZIP
WAST CONTRACTOR LICENSE li A -19_I13 c:4r:.O 8•$y !�4.4si::� ;yy_. CONTACT: 'j4' �-A-p P r
I�II,M+
PERMIT/BU1L01NG INFORMATION
COST OF PROJECT: Zt Z S — 30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:.
CONSTRUCTION TYPE;
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBSCIt 6P 19116RtC5.
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGWT SGTBACK•
MAIN FLOOR SO FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:__„
OTRUOTURCOOU I+fOrcnrvi t:IIIIEWGD IZASGIUGAIT'
'CRITICAL ARFAS:' ''" ��
GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE;
IMPERVIOUS 811RFAIIF ARFA!
FEB 03 2005 08:24 5094495504 PAGE.01
FROM : ALPINE CONSTRUCTION
r HA NU.
MANUFACTURE _ D HOME
WIDTH: LENGTH:_
YEAR: PIT SET:
MANUFACTURER:
rerusimmw RELOCATION
SQ FT OF SIGN:
* OF SIGNS:__.,
TYPE OF SIGN:
HEIGHT OF SIGN:
AREA OF EXIST SIGN
PREVIOUS ADDRESS:
PROPOSED USE:
'FIRE SPRINKLER: FIRE ALARM;..____._... --••
PAINT 800TH: TENT:, _—.._.
FIREWORKS DISPLAY:
BLASTING: DATE/TIME:_____...
WA STATE NON RESIDENTIAL ENERGY con,,,
PHONE: FAX:—
CITY, STATE. 'LIP
PLANS EXAMINER:
ADDRESS:
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
CMA1 INSPECTIONS
.._
SPECIAL INSPECTIONS
0 BUL I INC5 0 CONCRETE
FIRM NAME:
INSPECTOR(S):
RCINFORCEMENT
Q WELDING;
PHONE: FAX:
IS PUBLIC SEWER AVAILABLE:
1S PUBLIC WATER AVAILABLE:
I8 PROPERTY LOCATED WITHIN DESIGNATED STORMWATEIi uuN I'ri5L AREA: 0 VE0 0 NO
13 THE PROPERTY LOCATED WITHIN ASA: 0 YES. 0 NO PSSA: 0 YES 0 NO
13 YES 0 N0 ...
El
YES D NO
IF YES: CI COUNTY 0 CITY
IF. YES, WHICH WATER DIST/IRR:
METHOD OF PAYMENT
0 0
CASH CHECK
o vvKa.nnc —y[�
AUTHOR/ZED SIGNATURE; Po—, */ �'}"-`
MIERMIIM
11111•111111.11
1
This document originally contained
confidential credit card information which
was redacted pursuant to RCW 19.255.010
and the original document destroyed
pursuant to SOS DAN GS2014-030.
VIM0
*FAXED PERMIT APPUCATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
FEB 03 2005 08:24
5094485504 PAGE.02