2003, 10-23 Permit App: BLD-03-02874 RelocationS�1e'
p
lley
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: 0 u" ` sy,\,sdv,
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
C' -
PERMIT DESCRIPTION:
® BUILDING PERMIT
t RELOCATION
1
a CHANGE IN USE ® GRADING
11] SIGN ® TENANT
CI MANUFACTURED HOME
OTHER
OWNER / APPLICANT INFORMATION
1
° OWNER: ')Ptik
PHONE: t g(1 -(1) FAX:
ADDRESS: P. , ,C'L f (-1 I Oi S
APPLICANT:
PHONE: FAX:
TY,STATE, ZIPr Tip)/
(4 ADDRESS:
°CONTRACTOR: ® ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY, STATE, ZIP CITY, STATE, ZIP
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
CONTACT:
PERMIT/BUILDING INFORMATION
W
COST OF PROJEC G Soap
BUILDING HEIGHT TO PEAK: t a
BUILDING DIMENSIONS: 1\)
NUMBER OF STORIES:
NUMBER of BEDROOMS: N( PI -
FLANKING SETBACK: I b
FRONT SETBACK: )D
REAR SETBACK: I(✓
LEFT SETBACK: ISO
r
RIGHT SETBACK: i U
30% SLOPES ON PROPERTY: (\l
1
MAIN FLOOR SQ FT:r4J
OCCUPANCY GROUP: L-ocd-ivje 2N0 FLOOR SQ FT:
wv-•:\
CONSTRUCTION TYPE: rr�v�
✓,1-t
STRUCTURES ON PROPERTY: {-1,),,,,e/✓ly
CRITICAL AREAS: GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
UNFIN BASEMENT:
N q-
t./ 4
FINISHED BASEMENT: M
CURRENT WELL USE: N 1'7
IMPERVIOUS SURFACE AREA:
DECK:
N ft
1
MANUFACTURED HOME
SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN:
# OF SIGNS:
TYPE OF SIGN:
HEIGHT OF SIGN:
AREA OF EXIST SIGN:
RELOCATION
FIRE SAFETY
PREVIOUS ADDRESS: 1-v.4A G„'�, + ey— sieQr,
PROPOSED USE:
FIRE SPRINKLER:
PAINT BOOTH:
FIREWORKS DISPLAY:
FIRE ALARM:
TENT:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER:
ADDRESS:
PHONE: FAX:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING °CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE:
IS PUBLIC WATER AVAILABLE:
® YES ® NO
0
YES NO
IF YES: COUNTY CITY
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 0 NO
DATE:
METHOD OF PAYMENT:
0 0
PSSA: 0 YES ® NO
STAFF:
CASH CHECK
9
VISA
erl��■rr
BANKCARD 4°; EXPIRES: VIN #
AUTHORIZED SIGNATURE.:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
Spokane
../f Valley
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
RELOCATION
Job Address: 2809 N JOHNSON CT
SPOKANE WA 99212
Description: RELOCATE 32 X 24 GARAGE
(FROM SW CORNER OF INDIANA & EVERGREEN)
Subdivision:
Owner:
DEN MEN LLC
Applicant: DEN MEN LLC
Address: PO BOX 141994
SPOKANE, WA 99214-1994
Contractor:
Address:
Lot:
THIS IS NOT A PERMIT
Penalties will be assessed for
commencing work without a permit
Application #: BLD -03-02874
Applied:
Issued:
Expires:
Bik: Parcel No: 45092.2402
Phone: (509) 280-6420
Phone:
Lic No:
Zoning:
10/23/2003
04/20/2004
General Information:
VALUATION
BUILDING HEIGHT TO PEAK
DIMENSIONS
# OF STORIES
FRONT SETBACK
REAR SETBACK
LEFT SETBACK
RIGHT SETBACK
OCCUPANCY GROUP
CONSTRUCTION TYPE
STRUCTURES ON PROPERTY
SERVED BY SEPTIC SYSTEM
WELLS LOCATED ON PROPERTY
1751
12
32 X 24
1
50+
16
N/A
10
u-1
wood
2
no
no
Fees:
PLAN CHECK FEE
BASIC PERMIT FEE
RELOCATION INSPECTION FEE
WSBCC SURCHARGE
Total Calculated:
Deposits/Receipts:
Total Due:
25.26
63.15
60.00
4.50
152.91
60.00
92.91
CITY OF SPOKANE VALLEY
APPROVED FOR SUBMITTAL
Building
Planning l �1
Public Works.__111/
initials / Date
THIS IS NOT A RECEIPT
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425/251-1213
VANCOUVER
360/695-6600
ANCHORAGE
907/278-9546
SPOKANE
509/534-8502
EUGENE
541/465-9566
HAWAII
808/682-0845
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HARDWOODS, INC., WASHINGTON
RENTON
425/251-1213
VANCOUVER
360/695-6600
ANCHORAGE
907/278-9546
SPOKANE
509/534-8502
EUGENE HAWAII
541/465-9566 808/682-0845
HARDWOOD &SOFTWOOD LUMBER •• HARDWOOD & SOFTWOOD PLYWOOD • MELAMINE • VINYL • SPECIALTIES
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