2003, 07-11 Permit App: BLD-03-02030 Additionr
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILD/NG DIVISION
99707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: 1 0 3 S. Can cg pot_
ASSESSOR'S TAX PARCEL NUMBER(S): 5 J I q / 0 Z'
LEGAL DISCRIPTION: S 1n 5 lP F4../V“ V1 641.12...t( + n5
PERMIT DESCRIPTION: A,jcQ Ain v.) — as ft l8 - f-QrQlL. c9 Y� �O K (77-)ctret p
Ake P
0 MANUFACTURED HOME
BUILDING PERMIT 0 CHANGE IN USE ® GRADING
®RELOCATION
(3SIGN DTENANT
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OTHER
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OWNER / APPLICANT INFORMATION
® OWNER: U A In e 5 i`:I € j)
lil
PHONE: Q 2 a- a 555 FAX:
® APPLICANT: S E
PHONE: FAX:
ADDRESS: IO 3 5. lm an (.RD(d 2) ADDRESS:
&v'JJ e'n &c .z st, w%i c901 1p CITY,STATE, ZIP
CONTRACTOR: <l ✓1n (2)a-Kef
PHONE: cell-aao- 30o1 FA4cr -Ft5
ADDRESS:
CITY, STATE, ZIP
V
CITY, STATE, ZIP
ARCHITECT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # al) / L- H r'i S 0 3. N.1 CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 1 g 0
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS: P.-/3
FLANKING SETBACK:
X FRONT SETBACK: 419.15
REAR SETBACK:
-k LEFT SETBACK: I 1 12-5-
-9(- RIGHT SETBACK: 1 1.2 5
\Tart'ctnco_ i$-Av-01- 03
30%SLOPES ON PROPERTY: - (
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE: 100. l <?37
CURRENT PROPERTY USE:
CURRENT SEPTIC USE: L•�D
CURRENT WELL USE:
V
AAD
IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT: I (0 0
2ND FLOOR SQ FT:
UNFIN BASEMENT: A D
FINISHED BASEMENT: Nb
GARAGE:
COVERED DECK:
DECK:
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN: HEIGHT OF SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
RELOCATION FIRE SAFETY
1
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
BOLTING
FIRM NAME:
INSPECTOR(S):
CONCRETE
ISI
REINFORCEMENT
PHONE:
® WELDING
FAX:
BUILDING STAFF USE ONLY
1
IS PUBLIC SEWER AVAILABLE:
IS PUBLIC WATER AVAILABLE:
® YES ® NO
▪ YES • NO
IF YES:
It
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: YES NO
PSSA: ® YES ® NO
DATE:
1
STAFF:
1
METHOD OF PAYMENT.:
17
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CASH CHECK
ID
ID
VISA
BANKCARD #; EXP/RES: V/N#
AUTHOR/ZED SIGNATURE.
`FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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APPROVED BY-iy,
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