2004, 11-17 Permit App: 04009093 Remodel, Mechanical Fixtures.#\„,
*kw' e
\,o)Ac-
goci,3
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUN/TY DEVELOPMENT
BUILD/NG DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
r
1
STREET ADDRESS:
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: 6n// (h' Shj6,4e71/7— 3�L f ��l&k t 061,6-; ri
Q BUILDING PERMIT a CHANGE IN USE O GRADING •a MANUFACTURED HOME
QRELOCATION
Q SIGN 0 -TENANT
0-GfR...
OWNER / APPLICANT INFORMATION
bo OWNER: Prnt-iP ('. teeE(
PHONE: szij 07 z- /6 7s--- FAX:
ADDRESS: / 21(' /►'s 10,J4,../9Low
SPorA,,/E I�ALZ d/ 4 g40CITY,STATE, ZIP
CONTRACTOR:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
0
APPLICANT: c /'%E
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
ARCHITECT:
PHONE:
ADDRESS:
FAX:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
GARAGE:
NUMBER of BEDROOMS: CRITICAL AREAS:
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 x 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
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:
ADDRESS:
PHONE: FAX:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING °CONCRETE O REINFORCEMENT
FIRM NAME:
INSPECTOR(S):
PHONE:
WELDING
FAX:
1
BUILDING STAFF USE ONLY
1
IS PUBLIC SEWER AVAILABLE: ® YES 0 NO
IS PUBLIC WATER AVAILABLE: ® YES ® NO
IF YES: 0 COUNTY 0 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 0 NO
DATE:
1
STAFF:
METHOD OF PAYMENT:
0
CASH CHECK
BANKCARD /4; EXP/RES.` VIN#
AUTHORIZED SIGNATURE?
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD