2003, 10-10 Permit App: BLD-03-02739 Pole Buildingopummie
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BU/LD/NG DI VIS/ON
If 70 7 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax. • (5091688-0037
11 REQUIRED SITE INFORMATION II
STREET
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
dRUILDING PERMIT 13CHANGE IN USE E GRADING 1 MANUFACTURED SOME
[3RELOCATION O SIGN [3 TENANT ( OTHER
OWNER /APPLICANT INFORMATION
mmmm� 11
® OWNER: T6�AIA �A 06W ® APPLICANT: J �
PHONE: Aa l ZI9-27 FAX: PHONE: FAX:
ADDRESS: bg Q O '�la �JV��.tC_xH ADDRESS:
CITY,STATE, ZIP CITY, STATE, ZIP
®CONTRACTOR: ZtGCs`� ®ARCHITECT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE
PHONE: FAX:
ADDR
CONTACT:
IE PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK: 1�g
BUILDING DIMENSIONS: ZqX 3%
NUMBER OF STORIES:_
NUMBER of BEDROOMS: C�
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE: 46
CURRENT SEPTIC USE: 'NO
CURRENT WELL
IMPERVIOUS SURFACE AREA:
CITY, STATE, ZIP
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:u
COVERED DECK:
DECK:
01 MANUFACTURED HOME SIGN 11
WIDTH: LENGTH:
®
SQ FT OF SIGN:
HEIGHT OF SIGN:
YEAR: PIT SET:
CITY
# OF SIGNS:
AREA OF EXIST SIGN:
MANUFACTURER:
IS PUBLIC WATER AVAILABLE: YES NO
TYPE OF SIGN:
DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA:
® YES ® NO
®
®
RELOCATION
® YES ® NO
FIRE SAFETY
DATE:
STAFF:
PREVIOUS ADDRESS:
FIRE SPRINKLER:
FIRE ALARM:
® ® ®
CASH CHECK
PAINT BOOTH:
TENT:
PROPOSED USE:
FIREWORKS DISPLAY:
EXPIRES;
VIN #
BLASTING:
DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER:
ADDRESS:
INSPECTOR:
ADDRESS:
SPECIAL INSPECTIONS
PHONE:
PHONE:
F,
CITY, STATE, ZIP
CITY, STATE, ZIP
® BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:---
INSPECTOR(S):--------
I
AX:INSPECTOR(S):
BUILDING STAFF USE ONLY
® ®
®
®
IS PUBLIC SEWER AVAILABLE: YES NO
IF YES: COUNTY
CITY
U 13
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.-
® ® ®
CASH CHECK
® V % A
BANKCARD #,_
EXPIRES;
VIN #
AUTHORIZED SIGNATURE.•
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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