2004, 11-22 Permit App: 04009127 Reroof1�
N-7177
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:Qrr/ 6 //,
ASSESSOR'S TAX PARCEL NUMBER(S): f
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: l cc3a % 0 /4J
D BUILDING PERMIT ❑ CHANGE IN ITSE D GRADING D MANUFACTURED HOME
Q SIGN C}TENANT
CiRELOCATION
DOIHER.. •
OWNER / APPLICANT INFORMATION
OWNER: nig v -I4&, i,,'2?AY
D APPLICANT:
PHONE: FAX: PHONE: FAX:
-1029
- • - -- // /1&' fi
4 ADDRESS:
CITY,STATE, ZIP
CITY, STATE, ZIP
®CONTRACTOR:// _ /) $ /200 ((l/5? • ARCHITECT.:
C (D
PHONE: 7370'0 FAX: 6 5 V// PHONE: FAX:
ADDRESS: /0) ,g7/t a.2 K3 2 7 C o/ -eve,c-u q „ADDRESS:
/ ITY, STATE, ZIP 0 CITY, STATE, ZIP
CONTACT:
WA ST CONTRACTOR LICENSE #
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 51 0 D
30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT
BUILDING DIMENSIONS:
NUMBER OF STORIES:
CONSTRUCTION TYPE: UNFIN BASEMENT:
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: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
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/T1M E:
WA STATE NON-RESIDENTIAL ENERGY CODE 1
PLANS EXAMINER:
PHONE: FAX:
ADDRESS:.
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING
FIRM NAME:
INSPECTOR(S):
0 CONCRETE
REINFORCEMENT
PHONE:
vitwaessimississi
® WELDING
FAX:
1 BUILDING STAFF USE ONLY
1
IS PUBLIC SEWER AVAILABLE: ® YES 0 NO IF YES: CI 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: ® YES 0 NO PSSA: 0 YES 0 NO
DATE:
1
STAFF:
METHOD OF PAYMENT:
0
CASH CHECK
VISA
BANKCARD #; EXPIRES; VIN #
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD