2003, 09-18 Permit App: BLD-03-02502 MHPERMIT 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
STREET ADDRESS:
REQUIRED SITE INFORMATION
1b51-5. E, hi.-lyv 111C)) 11)11-4,
ASSESSOR'S TAX PARCEL NUMBER(S): 4/573 / 2 ),
LEGAL DISCRIPTION:
94037
PERMIT DESCRIPTION: / it Q/' 1,01‘.
O BUILDING PERMIT 0 CHANGE IN USE 0GRADING
MRELOCATION
0 -SIGN M TENANT
MOTHER
ACTURED HOME
OWNER / APPLICANT INFORMATION
i
*OWNER: /642,. F/.4/4
PHONE: 32 b `) 53 FAX:
APPLICANT: stLtiriL
PHONE: FAX:
ADDRESS: 11 tis 41, , i/Ih xI.- 5 of '940)01/ ADDRESS:
CITY,STATE, ZIP CITY, STATE, ZIP
IP
CONTRACTOR: c Qtkf a. IO dt� de,trtez ® ARCHITECT:
PHONE: 535--In/7/:,7 FAX: S -1I -C$'3$ - 2425.
PHONE:
ADDRESS: %?Sb> F. `,i01-itA.OL. jagl(1Ls�q �(/�lf ADDRESS:
CITY,. STATE, ZIP',,.?/z_
FAX:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE:
FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: DECK:
REAR SETBACK: CURRENT SEPTIC USE:
LEFT SETBACK:
RIGHT SETBACK:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA: 1 I
aw.ccu),H4.i2AAAjc
10,"
MANUFACTURED HOME SIGN
WIDTH: 140
YEAR: 2-00 le
LENGTH: 5 2 -
PIT SET: �.Pq
MANUFACTURER: / ,04e./4 -7-
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
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
0 BOLTING °CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO IF YES: 0 COUNTY 0 CITY
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 0 NO PSSA: 0 YES 0 NO
DATE:
1
STAFF:
METHOD OF PAYMENT:
0 0
CASH CHECK
VISA
BANKCARD #; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
Splkane
Valley
Call 24 hours before inspection required
Phone 509.688-0036 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date Permit # PWQ3_21 s
APPROACH PERMIT
APPLICATION AS-a-
(Address/Parcel
Location of property #, if available)
Applicant Name 34-, /G€ LE 1-1xte
Address 1"s> S all4,.` Phone 3�cf—" 7)-(33
Contractor's Name eitAiK€/e 42'j lsi-r�;s
Address 1O_z r Co. eoservp o d-s,,t) Phone 4:/(2---
Contractor's
:/6
Contractor's Reg# 990_b€ Expires
PROJECT DESCRIPTION (Provide site sketch)
Residential Driveway
Existing Curb & Gutter
Culvert Installation
Other conditions
Commercial/Industrial Driveway
Rural Road Section
Sidewalk Repair/Construction
See construction requirements and details on reverse. Bond/insurance certification must be on
file with the City.
SPECIAL CONDITIONS:
PERMIT FEE $
Inspection Fee$
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card # Expiration Date
Name of Holder
Signature
Fees Paid$ Date Init
Excerpts from Spokane Valley Standards (3.24, and details A8 and A -8a):
• Every driveway approach must provide access to an off road parking area located
on private property. The driveway shall be of sufficient length so a vehicle in the
driveway does not project into the road right of way, sidewalk, or pathway.
• Public or private driveways in industrial, commercial, multiple family, church or
any like use shall be constructed to allow vehicles to exit without backing onto a
public road.
• Driveway approaches shall be constructed to avoid interference with existing
drainage inlets, culverts, road lighting standards, utility poles, traffic regulating
devices, fire hydrants or other public utilities. The applicant shall bear the cost of
relocating any such public facility.
• Driveway approach grades within the right of way shall not exceed 8% In urban
area, or 2% in rural areas. Driveway grades shall not exceed 10% within ten feet of
a city right of way.
See Standards for a more complete listing of requirements.
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