2003, 10-27 Permit App: BLD-03-02902 Remodelcrrr
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jValley
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:
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
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PERMIT DESCRIPTION: v Q4s &»4cvv; i FAA' rX1
D•DING PERMIT
0RELOCATIUN
14,4 ,r� �.s � ' 'L / � ply
CI.CRANGE •USE • 13 -GRADING •a.NIANTIFACTURED $O1viE
0 -SIGN - 0 -TENANT CI -OTHER...
OWNER / APPLICANT INFORMATION
® OWNER: D.»40 P11711- L (A
PHONE: S d `l I2 2 1/7? C FAX:
® APPLICANT:
PHONE: FAX:
Ave
ADDRESS: 1'1°712 c.! SPS ,
( Lc I FLz c c /}dc ei 9 Z• t ADDRESS:
CITY,STATE, ZIP ..
CONTRACTOR:
PHONE:
FAX:
ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
CITY, STATE, ZIP
ARCHITECT.:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: / / 7C
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
'NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
UNFIN BASEMENT:
STRUCTURES ON PROPERTY: FINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
ANUFACTURED HOME
SIGN
WIDTH:
YEAR:
MANUFACTURER:
LENGTH:
PIT SET:
SQ FT OF SIGN: HEIGHT or 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 I E:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER:
ADDRESS:
PHONE: FAX:
INSPECTOR:
ADDRESS:
CITY, STATE, ZIP
PHONE: FAX:
CITY, STATE, ZIP
SPECIAL NSPECTIONS
CI BOLTING
FIRM NAME:
INSPECTOR(S):
°CONCRETE
a REINFORCEMENT
° WELDING
PHONE: FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 1:3 YES NO
1:3
O 0
IS PUBLIC WATER AVAILABLE: YES NO IF YES, WHICH WATER DIST/MR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: IC:3 YES 11:3 NO PSSA: CI YES 13 NO
IF YES: • COUNTY CITY
DATE:
STAFF:
HOD OF YMENT
E
CASH CHECK
BANKCARD EXPIRES: VIN #
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD